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Tran C, Nunez C, Eslick GD, Barker R, Elliott EJ. Complications of button battery ingestion or insertion in children: a systematic review and pooled analysis of individual patient-level data. World J Pediatr 2024:10.1007/s12519-024-00833-y. [PMID: 39168931 DOI: 10.1007/s12519-024-00833-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/20/2024] [Accepted: 07/18/2024] [Indexed: 08/23/2024]
Abstract
BACKGROUND Button battery (BB) exposures are common in children and can have devastating consequences. We reviewed current evidence on the complications associated with BB exposure and identified predictors of outcomes using individual patient-level data. DATA SOURCES We carried out a systematic review and pooled analysis by searching MEDLINE, Embase, and Scopus up to May 19, 2023. Included studies describe complications following BB exposures in children (aged < 18 years). Odds ratios (ORs) were calculated using binary logistic regression to measure associations between predictive factors and different outcomes. RESULTS Two-hundred seventeen studies (439 children) were included. The median age at presentation was 1.75 [interquartile range (IQR) 1.00-3.00] years and 399 (90.9%) exposures were ingestions. Of the 380 cases reporting sex, 162 (42.6%) were female. Feeding (192, 48.1%) and respiratory difficulties (138, 34.6%) were common presenting features for ingestions, while symptomatology was site-specific for insertions. Common complications included oesophageal mucosal damage alone (105, 26.3%) and tracheooesophageal fistula (93, 23.3%) for ingestions, and nasal septal perforation (22, 55.0%) and mucosal damage alone (13, 32.5%) for insertions. Intestinal perforation occurred in 2.5% of ingestion cases, including perforation of Meckel's diverticulum, peritonitis, and jejunocolic fistula. Vascular complications were common among children who died. Age (≤ 2 years), battery exposure duration (> 6 hours), and battery diameter (≥ 20 mm) were associated with common and severe complications of ingestions. CONCLUSION BB injuries are time-critical, with severe sequelae predominantly affecting young children. Diagnosis is challenging. Preventative work through regulation and safer battery design are required to eliminate this problem.
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Affiliation(s)
- Christopher Tran
- Sydney Medical School, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia
- The Australian Paediatric Surveillance Unit, Level 2, Kids Research, The Sydney Children's Hospital Network (Westmead), Locked Bag 4001, Westmead, NSW, 2145, Australia
| | - Carlos Nunez
- Sydney Medical School, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia.
- The Australian Paediatric Surveillance Unit, Level 2, Kids Research, The Sydney Children's Hospital Network (Westmead), Locked Bag 4001, Westmead, NSW, 2145, Australia.
| | - Guy D Eslick
- Sydney Medical School, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia
- The Australian Paediatric Surveillance Unit, Level 2, Kids Research, The Sydney Children's Hospital Network (Westmead), Locked Bag 4001, Westmead, NSW, 2145, Australia
| | - Ruth Barker
- Queensland Children's Hospital, Brisbane, QLD, Australia
- Queensland Injury Surveillance Unit, Jamieson Trauma Institute, Royal Brisbane and Women's Hospital, Herston, QLD, Australia
| | - Elizabeth J Elliott
- Sydney Medical School, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia
- The Australian Paediatric Surveillance Unit, Level 2, Kids Research, The Sydney Children's Hospital Network (Westmead), Locked Bag 4001, Westmead, NSW, 2145, Australia
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Dembiński Ł, Copley S, Koletzko B, Grossman Z, Del Torso S, Mujkić-Klarić A, Hadjipanayis A. European paediatricians need to be more aware of the risks faced by children who swallow button batteries and how to treat them. Acta Paediatr 2024. [PMID: 39166798 DOI: 10.1111/apa.17393] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/07/2024] [Revised: 08/01/2024] [Accepted: 08/07/2024] [Indexed: 08/23/2024]
Abstract
AIM The aim of this study was to assess how aware European paediatricians were of the risks faced by children who swallowed button batteries and the advice for managing such cases. METHODS An Internet-based survey was conducted among European paediatricians between 1 April 2023 and 31 May 2023. The researchers contacted members of the European Academy of Paediatrics Research in Ambulatory Setting Network and a number of European national paediatric societies. RESULTS Responses were received from 605 paediatricians (66.0% females) in 41 countries and 64.5% had encountered cases of button battery ingestion. Only 31.2% had received specific training and only 35.7% were familiar with the advice issued by the European Society for Paediatric Gastroenterology, Hepatology and Nutrition and the European Academy of Pediatrics. While 90.8% of respondents correctly recognised the need for hospitalisation of a child after button battery ingestion, only 30.1% of them identified all symptoms and 58.2% could accurately determine the appropriate diagnostic scope. One in ten underestimated the health or life risks. These deficiencies were significantly attributed to a lack of adequate training (p < 0.01). The overwhelming majority of the respondents expressed the need to increase awareness among physicians and childcare providers, mainly through social media campaigns and advertisements. CONCLUSION European paediatricians were insufficiently aware of button battery ingestion risks and management, with significant gaps in training and familiarity with advice. Respective education for medical practitioners and raising public awareness should be markedly strengthened.
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Affiliation(s)
- Łukasz Dembiński
- The European Academy of Paediatrics (EAP), Brussels, Belgium
- Department of Pediatric Gastroenterology and Nutrition, Medical University of Warsaw, Warsaw, Poland
| | - Sian Copley
- The European Academy of Paediatrics (EAP), Brussels, Belgium
- Paediatric Gastroenterology, Royal Manchester Children's Hospital, Manchester, UK
| | - Berthold Koletzko
- The European Academy of Paediatrics (EAP), Brussels, Belgium
- Department of Paediatrics, Dr. von Hauner Children's Hospital, LMU University Hospital, Munich, Germany
| | - Zachi Grossman
- The European Academy of Paediatrics (EAP), Brussels, Belgium
- Adelson School of Medicine, Ariel University, Ariel, Israel
| | - Stefano Del Torso
- The European Academy of Paediatrics (EAP), Brussels, Belgium
- ChildCare WorldWide, Padova, Italy
| | - Aida Mujkić-Klarić
- The European Academy of Paediatrics (EAP), Brussels, Belgium
- Andrija Stampar School of Public Health, School of Medicine, University of Zagreb, Zagreb, Croatia
| | - Adamos Hadjipanayis
- The European Academy of Paediatrics (EAP), Brussels, Belgium
- Medical School, European University Cyprus, Nicosia, Cyprus
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Powers K, Baldassari C, Lucas J. Pediatric Esophageal Foreign Bodies and Caustic Ingestions. Otolaryngol Clin North Am 2024; 57:623-633. [PMID: 38519292 DOI: 10.1016/j.otc.2024.02.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/24/2024]
Abstract
Foreign body ingestions commonly occur in children aged under 6 years. While serious complications of ingestions are rare, sharp objects, caustics, multiple magnets, and button batteries can be associated with poorer outcomes including gastrointestinal (GI) obstruction, perforation, necrosis, and fistula formation. Initial workup should include history, physical examination, and plain film radiographs that will identify radiopaque objects. Removal of the foreign body is typically warranted if the object is high risk, it is located higher up in the GI tract, the patient is symptomatic, or the object is retained for a prolonged amount of time.
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Affiliation(s)
- Kristina Powers
- Department of Otolaryngology-Head and Neck Surgery, Eastern Virginia Medical School, Norfolk, VA, USA
| | - Cristina Baldassari
- Department of Otolaryngology-Head and Neck Surgery, Eastern Virginia Medical School, Children's Hospital of the King's Daughters, Norfolk, VA, USA
| | - Jordyn Lucas
- Department of Otolaryngology-Head and Neck Surgery, Eastern Virginia Medical School, Children's Hospital of the King's Daughters, Norfolk, VA, USA.
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Ebrahimi P, Nazari R, Mousavinezhad SM, Senobari N, Ghadimi DJ. Successful management of a delayed presented button battery ingestion in a toddler: A case report and literature review. Clin Case Rep 2024; 12:e9275. [PMID: 39114847 PMCID: PMC11303662 DOI: 10.1002/ccr3.9275] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2024] [Revised: 06/22/2024] [Accepted: 07/13/2024] [Indexed: 08/10/2024] Open
Abstract
Key Clinical Message It is important to note that prevention of button battery ingestion is the most effective way to reduce its incidence and complications. This is unachievable without providing educational plans for parents. Moreover, triage nurses and first-line staff who take the history of patients and physicians should take the history to evaluate the risk of battery ingestion. Plain radiographs can be helpful in this matter, as the presence of "Hallow" and "Steep" signs in the anteroposterior and lateral views, respectively, can help. Abstract Foreign body ingestion is a relatively common occurrence in pediatrics, especially among children 1-3 years of age. Although most cases are benign and managed conservatively, those with high-risk subjects such as button batterie can bring about fatal conditions in the minority of cases. In the present study, the history, diagnostic, and therapeutic procedures of a 13-month-old baby with the final diagnosis of button battery ingestion are presented. The parents ignored the symptoms, suspecting that it was a viral infection. The evaluations showed that a battery was lodged in the middle part of the thoracic esophagus, which was removed by an urgent endoscopic procedure. The patient was under observation and on a nothing-by-mouth diet for a week, receiving nutritional fluid with a nasogastric tube. The necrosis, which was obvious after the removal of the battery, was healing in the second control esophagogastroduodenoscopy performed 1 week after the procedure. The stricture was minimal, and no need for dilation was diagnosed. This case report underscores the importance of a timely diagnosis and removal of these cases. This case underscores the importance of the timely presentation of these cases to health care and the risk of delayed removal, such as necrosis, forming fistula, and perforation of the esophagus. The delay can cause necrosis, fistula, and perforation and might lead to irreversible severe complications and even death.
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Affiliation(s)
- Pouya Ebrahimi
- Tehran Heart Center, Cardiovascular Disease Research InstituteTehran University of Medical SciencesTehranIran
| | - Roozbeh Nazari
- Department of CardiologyModarres Hospital, Shahid Beheshti University of Medical SciencesTehranIran
| | | | - Nahid Senobari
- Department of CardiologyModarres Hospital, Shahid Beheshti University of Medical SciencesTehranIran
| | - Delaram J. Ghadimi
- School of Medicine, Shahid Beheshti University of Medical SciencesTehranIran
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Jomsky BM, Patel HJ, Smith T. Ingestion of 14 Hearing Aid Batteries in an Adult Patient. Cureus 2024; 16:e64354. [PMID: 39130971 PMCID: PMC11316670 DOI: 10.7759/cureus.64354] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/11/2024] [Indexed: 08/13/2024] Open
Abstract
Battery ingestion is not a common occurrence in adults. When it occurs in patients of any age, prompt action might be necessary, depending on the type of battery ingested, to prevent damage to the gastric mucosa that is involved in important secreting and absorbing functions required to maintain homeostasis. A 61-year-old Hispanic male presented to the emergency department with the chief concern of shortness of breath and abdominal pain. Incidentally, an X-ray demonstrated multiple round hyperdense foreign bodies in the ileum and cecum. Physical exam was positive for right-sided and periumbilical abdominal pain without any peritoneal signs. Upon colonoscopy, 14 hearing aid batteries of size 312 were discovered without evidence of perforation or obstruction. Ingestion of batteries in adults is a rare phenomenon. When an adult presents with ingestion of dangerous foreign bodies such as batteries, mental health is critical to consider in the history and treatment plan.
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Affiliation(s)
- Breanna M Jomsky
- Medicine, Lake Erie College of Osteopathic Medicine - Bradenton Campus, Bradenton, USA
| | - Hiren J Patel
- Medicine, Nova Southeastern University Dr. Kiran C. Patel College of Osteopathic Medicine, Fort Lauderdale, USA
| | - Travis Smith
- Clinical Curriculum Integration and Assessment, Lake Erie College of Osteopathic Medicine - Bradenton Campus, Bradenton, USA
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Paladin I, Mizdrak I, Gabelica M, Golec Parčina N, Mimica I, Batinović F. Foreign Bodies in Pediatric Otorhinolaryngology: A Review. Pediatr Rep 2024; 16:504-518. [PMID: 38921707 PMCID: PMC11207020 DOI: 10.3390/pediatric16020042] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/09/2024] [Revised: 06/13/2024] [Accepted: 06/14/2024] [Indexed: 06/27/2024] Open
Abstract
Foreign bodies (FBs) in pediatric otorhinolaryngology represent up to 10% of cases in emergency departments (ED) and are primarily present in children under five years old. They are probably the result of children's curiosity and tendency to explore the environment. Aural and nasal FBs are the most common and accessible, and the removal methods differ depending on the exact location and type of FB, which can be organic or inorganic. A fish bone stuck in one of the palatine tonsils is the most common pharyngeal FB. Laryngopharyngeal FBs can obstruct the upper respiratory tract and thus become acutely life-threatening, requiring an urgent response. Aspiration of FBs is common in children between 1 and 4 years old. A history of coughing and choking is an indication of diagnostic and therapeutic methods to rule out or confirm a tracheobronchial FB. Regardless of the availability of radiological diagnostics, rigid bronchoscopy is the diagnostic and therapeutic method of choice in symptomatic cases. Radiological diagnostics are more significant in treating esophageal FBs since most are radiopaque. Flexible or rigid esophagoscopy is a successful method of removal. A delayed diagnosis, as with tracheobronchial FBs, can lead to fatal consequences.
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Affiliation(s)
- Ivan Paladin
- Department of ENT and Head and Neck Surgery, University Hospital of Split, Spinciceva 1, 21000 Split, Croatia; (I.M.); (M.G.); (N.G.P.); (F.B.)
| | - Ivan Mizdrak
- Department of ENT and Head and Neck Surgery, University Hospital of Split, Spinciceva 1, 21000 Split, Croatia; (I.M.); (M.G.); (N.G.P.); (F.B.)
| | - Mirko Gabelica
- Department of ENT and Head and Neck Surgery, University Hospital of Split, Spinciceva 1, 21000 Split, Croatia; (I.M.); (M.G.); (N.G.P.); (F.B.)
| | - Nikolina Golec Parčina
- Department of ENT and Head and Neck Surgery, University Hospital of Split, Spinciceva 1, 21000 Split, Croatia; (I.M.); (M.G.); (N.G.P.); (F.B.)
| | - Ivan Mimica
- Department of ENT, General Hospital Sibenik, 22000 Sibenik, Croatia;
| | - Franko Batinović
- Department of ENT and Head and Neck Surgery, University Hospital of Split, Spinciceva 1, 21000 Split, Croatia; (I.M.); (M.G.); (N.G.P.); (F.B.)
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Xu G, Jia D, Chen J, Pan H, Wu Z. Esophageal button battery impactions in children: an analysis of 89 cases. BMC Pediatr 2024; 24:388. [PMID: 38851720 PMCID: PMC11162056 DOI: 10.1186/s12887-024-04869-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/09/2024] [Accepted: 06/03/2024] [Indexed: 06/10/2024] Open
Abstract
OBJECTIVE To analyze the clinical characteristics of esophageal button battery impactions in children and explore safe and effective treatment methods. METHODS This retrospective cohort study was conducted at a single tertiary care center, Shenzhen Children's Hospital, encompassing 89 children diagnosed with esophageal button battery impactions between January 2013 and January 2023. To minimize esophageal mucosal corrosion, prompt removal of the button battery with a first-aid fast track rigid esophagoscopy under general anesthesia was performed within thirty minutes of diagnosis. The clinical features and complications were recorded and analyzed. RESULTS Button battery as esophageal foreign body was prevalent among children under 3 years old (79.8%), with boys exhibiting a higher incidence rate (56.2%) compared to girls (43.8%), and an average age of 25.8 months. The median duration from ingestion to hospital admission was 3 h (range: 0.5 h to 3 months). Common symptoms included vomiting and dysphagia, with early stage vomiting of brown foamy secretions being a characteristic presentation of esophageal button battery impactions. The majority (77.5%) of batteries were lodged in the upper esophagus. The larger batteries were verified to be more prone to complications. All 89 cases exhibited varying degrees of esophageal mucosal erosion, with 31 cases (34.8%) experiencing severe complications, including esophageal stenosis in 11 cases (35.5%), esophageal perforation in 9 cases (29%) with 4 cases of tracheoesophageal fistula, vocal cord paralysis in 6 cases (19.4%), hemorrhage in 2 cases (6.5%), mediastinitis in 2 cases (6.5%), and periesophageal abscess in 1 case (3.2%). Despite the severity of these complications, none of the patients died after emergency surgery. CONCLUSION Esophageal button battery impactions can lead to significant damage to the esophageal mucosa due to its strong corrosiveness. Prompt action is crucial to mitigate the risk of complications. For the first time, we implement a first-aid fast track surgical intervention following diagnosis is imperative to minimize the incidence of adverse outcomes.
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Affiliation(s)
- Guo Xu
- Department of Otorhinolaryngology, Shenzhen Children's Hospital, 7019 Yitian Road, Futian District, Shenzhen, Guangdong, 518038, China
| | - Desheng Jia
- Department of Otorhinolaryngology, Shenzhen Children's Hospital, 7019 Yitian Road, Futian District, Shenzhen, Guangdong, 518038, China
| | - Jing Chen
- Department of Otorhinolaryngology, Shenzhen Children's Hospital, 7019 Yitian Road, Futian District, Shenzhen, Guangdong, 518038, China
| | - Hongguang Pan
- Department of Otorhinolaryngology, Shenzhen Children's Hospital, 7019 Yitian Road, Futian District, Shenzhen, Guangdong, 518038, China
| | - Zebin Wu
- Department of Otorhinolaryngology, Shenzhen Children's Hospital, 7019 Yitian Road, Futian District, Shenzhen, Guangdong, 518038, China.
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Wang F, Hu C, Zhu Z, Wu D, Shu M. Clinical Characteristics of Children With Foreign Bodies in the Digestive Tract and Analysis of Risk Factors for Serious Complications. Clin Pediatr (Phila) 2024:99228241253344. [PMID: 38756001 DOI: 10.1177/00099228241253344] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/18/2024]
Abstract
Foreign bodies (FBs) in the digestive tract are common in children, we analyzed the clinical characteristics of children with FBs in the digestive tract and discuss the risk factors for serious complications. We retrospectively reviewed clinical data of 139 children with FBs in the digestive tract. Based on the severity of complications caused by FBs, the patients were divided into risk and general groups for analysis and comparison. Significant differences were observed in the retention sites of FBs, the diameter of FBs retained in the esophagus, FBs retention time exceeding 24 h, and the absence of witnesses between the 2 groups. Inadequate care, button batteries (BBs), ingested mmFBs, FBs retained in the esophagus, long-term retention, and giant gastric bezoars may cause serious complications. In addition to treating FBs and the complications, clinicians should emphasize the importance of childcare to prevent the ingestion of FBs.
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Affiliation(s)
- Fengge Wang
- Department of Gastroenterology, Maternal and Child Health Hospital of Hubei Province, Wuhan, China
| | - Chijun Hu
- Department of Gastroenterology, Maternal and Child Health Hospital of Hubei Province, Wuhan, China
| | - Zhenni Zhu
- Department of Gastroenterology, Maternal and Child Health Hospital of Hubei Province, Wuhan, China
| | - Daiqin Wu
- Department of Gastroenterology, Maternal and Child Health Hospital of Hubei Province, Wuhan, China
| | - Meng Shu
- Department of Gastroenterology, Maternal and Child Health Hospital of Hubei Province, Wuhan, China
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Kinjalk M, Sehgal M, Ratan SK, Jain N, Gupta CK, Neogi S, Kumar P, Bhoria D, Arora V, Chellani G. Foreign Body Ingestion in Children: An Experience of 99 Cases in a Tertiary Care Center in Delhi. J Indian Assoc Pediatr Surg 2024; 29:223-232. [PMID: 38912028 PMCID: PMC11192268 DOI: 10.4103/jiaps.jiaps_183_23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2023] [Revised: 10/18/2023] [Accepted: 11/12/2023] [Indexed: 06/25/2024] Open
Abstract
Background Accidental ingestion of foreign bodies in children is critical, as the inability to effectively communicate can potentially lead to devastating consequences. We aimed to determine the epidemiology of foreign body ingestion and variability according to age, gender, type, and location of foreign body, and describe its management. Aim and Objective The aim was to study the various types of foreign body ingestions in children admitted to pediatric surgery and their management. Materials and Methods A retrospective study was conducted from January 2020 to June 2022 on children under the age of 12 years with a confirmed diagnosis of foreign body ingestion. Patients were clinically and radiologically assessed, after which standard protocols were followed wherein patients were followed by either observation or emergent management. Emergent management included removal of the foreign body by either endoscopy or surgery. Comparisons among multiple age groups, gender, type of foreign body, location of foreign body, and their management were analyzed. Results Out of 99 subjects in our study, there were 76 boys and 23 girls. The median age of presentation was 5 years. Most children were asymptomatic at presentation. The most frequently ingested foreign body was a coin in all age groups. The majority of the foreign bodies were suspected to be in the small bowel. The foreign bodies that had crossed the duodenojejunal flexure (n = 74, 74.7%) were managed conservatively with the observation of a variable period of a minimum of 24 h and a maximum of 48 h. 21 cases were managed by endoscopic removal, while three cases required surgical intervention. Conclusions Overall, the most common gastrointestinal foreign body was a coin in all age groups. Button battery is the most worrisome foreign body; however, depending on its position, it can be managed conservatively. Upper GI foreign bodies can be safely removed endoscopically. Parental counseling is very important for the prevention of ingestion of foreign bodies.
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Affiliation(s)
- Meghna Kinjalk
- Department of Pediatric Surgery, Maulana Azad Medical College, New Delhi, India
| | - Mehak Sehgal
- Department of Pediatric Surgery, Maulana Azad Medical College, New Delhi, India
| | - Simmi K. Ratan
- Department of Pediatric Surgery, Maulana Azad Medical College, New Delhi, India
| | - Nitin Jain
- Department of Pediatric Surgery, Maulana Azad Medical College, New Delhi, India
| | | | - Sujoy Neogi
- Department of Pediatric Surgery, Maulana Azad Medical College, New Delhi, India
| | - Prafull Kumar
- Department of Pediatric Surgery, Maulana Azad Medical College, New Delhi, India
| | - Dhruv Bhoria
- Department of Pediatric Surgery, Maulana Azad Medical College, New Delhi, India
| | - Vanshika Arora
- Department of Pediatric Surgery, Maulana Azad Medical College, New Delhi, India
| | - Gautam Chellani
- Department of Pediatric Surgery, Maulana Azad Medical College, New Delhi, India
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Chiew AL, Lin CS, Nguyen DT, Sinclair FAW, Chan BS, Solinas A. Home Therapies to Neutralize Button Battery Injury in a Porcine Esophageal Model. Ann Emerg Med 2024; 83:351-359. [PMID: 37725021 DOI: 10.1016/j.annemergmed.2023.08.018] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2023] [Revised: 07/08/2023] [Accepted: 08/14/2023] [Indexed: 09/21/2023]
Abstract
STUDY OBJECTIVE Button battery ingestion can cause alkaline esophageal injury. There is interest in first-aid household products to neutralize the injury. The objective was to investigate which household products are effective at reducing button battery injury. METHODS Two cadaveric porcine experiments were performed. Experiment 1 utilized esophageal mucosal segments. A button battery (3VCR2032) was placed onto the mucosa, and substances (saline control, honey, jam, orange juice, yogurt, milk, and cola) were applied every 10 minutes for 6 applications. Tissue pH was measured every 10 minutes, and macroscopic ulceration size was assessed at 120 minutes. Experiment 2 used an intact esophageal model with a battery inserted into the lumen and jam, honey, and saline irrigation as per experiment 1. Tissue pH, macroscopic and histopathology changes were evaluated at 60, 90 and 120 minutes. RESULTS In experiment 1, only honey and jam had a lower mean tissue pH at 120 minutes (8.0 [standard deviation [SD] 0.9, n=12] and 7.1 [SD 1.7, n=12], respectively) compared to saline solution 11.9 (SD 0.6, n=6, P<.0001). Both honey (0.24 cm2, SD 0.17) and jam (0.37 cm2, SD 0.40) had smaller mean areas of ulceration compared to saline solution (3.90 cm2, SD 1.03, P<.0001). In experiment 2, honey and jam had significantly lower mean tissue pH at all timepoints compared to saline solution. Histologic changes were evident at 60 minutes in the saline group, whereas honey and jam exhibited no or minimal changes until 120 minutes. CONCLUSIONS Honey and jam were able to neutralize injury caused by a button battery resulting in a smaller area of ulceration. Jam should be further explored as a possible first-aid option as an alternative to honey in suspected button battery ingestion prior to definitive management.
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Affiliation(s)
- Angela L Chiew
- Department of Clinical Toxicology, Prince of Wales Hospital, Randwick, NSW, Australia; University of New South Wales, Prince of Wales Clinical School, Faculty of Medicine, Sydney, NSW, Australia.
| | - Calvin S Lin
- University of New South Wales, Prince of Wales Clinical School, Faculty of Medicine, Sydney, NSW, Australia
| | - Dan T Nguyen
- Department of Anatomical Pathology, Prince of Wales Hospital, NSW Health Pathology, Randwick, NSW, Australia
| | - Felicity A W Sinclair
- Department of Anatomical Pathology, Prince of Wales Hospital, NSW Health Pathology, Randwick, NSW, Australia
| | - Betty S Chan
- Department of Clinical Toxicology, Prince of Wales Hospital, Randwick, NSW, Australia; University of New South Wales, Prince of Wales Clinical School, Faculty of Medicine, Sydney, NSW, Australia
| | - Annalisa Solinas
- Department of Anatomical Pathology, Prince of Wales Hospital, NSW Health Pathology, Randwick, NSW, Australia
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Krencnik T, Jalsovec T, Klemenak M, Riznik P, Dolinsek J. Safety beyond Sight: Handheld Metal Detectors as Diagnostic Allies in the Management of Children Suspected to have Ingested Foreign Bodies. Diagnostics (Basel) 2024; 14:356. [PMID: 38396396 PMCID: PMC10887526 DOI: 10.3390/diagnostics14040356] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2024] [Revised: 02/01/2024] [Accepted: 02/02/2024] [Indexed: 02/25/2024] Open
Abstract
BACKGROUND Foreign body (FB) ingestion remains a common cause of pediatric emergency department referrals, and the gold standard for detection is whole-digestive-tract radiographic examination. Our study explores whether handheld metal detectors (HHMD) can effectively identify the presence and location of ingested metal objects, potentially reducing the need for additional radiographic examination. METHODS We collected medical data from children with suspected metal FB ingestion who were referred to our emergency department (October 2017-March 2023), focusing on object type and correlating metal detector findings with radiographic images. RESULTS Data from 43 children (39.5% female; mean age: 4 y) referred to our emergency department were analyzed. Coins (32.6%), button batteries (18.6%), and hairpins (11.6%) were the most common ingested objects. Metal detectors detected the presence of FBs in 81.4% of cases (sensitivity: 89.7%; specificity: 100%). Radiographs, taken for 40 children, showed that the most common locations were the stomach (37%) and intestine (33%). The metal detector signals matched the radiography results in 69.8% of cases. According to HHMD, 34.9% of objects were accessible via endoscopy, contrasting with 51.2% via radiography (p < 0.05). CONCLUSION While the findings obtained using handheld metal detectors often correlate well with radiograph findings in detecting metal FBs, for an important number of children, this confirmation is lacking, especially when determining the exact location of an object.
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Affiliation(s)
- Tomaz Krencnik
- Department of Pediatrics, University Medical Centre Maribor, 2000 Maribor, Slovenia (J.D.)
| | - Tadej Jalsovec
- Department of Pediatrics, University Medical Centre Maribor, 2000 Maribor, Slovenia (J.D.)
| | - Martina Klemenak
- Department of Pediatrics, University Medical Centre Maribor, 2000 Maribor, Slovenia (J.D.)
| | - Petra Riznik
- Department of Pediatrics, University Medical Centre Maribor, 2000 Maribor, Slovenia (J.D.)
| | - Jernej Dolinsek
- Department of Pediatrics, University Medical Centre Maribor, 2000 Maribor, Slovenia (J.D.)
- Medical Faculty, University of Maribor, 2000 Maribor, Slovenia
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Bada-Bosch I, Blanco Verdú MD, Cerdá JA, Fanjul M, Ordoñez J, Tolín Hernani MM, Miranda Cid C, Sánchez Sánchez C, De Agustín JC. Can We Do Anything Else before Removing a Button Battery from the Esophagus?-Hyaluronic Acid. Eur J Pediatr Surg 2024; 34:56-62. [PMID: 37406675 DOI: 10.1055/a-2123-5214] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 07/07/2023]
Abstract
OBJECTIVE This article tests the protective effect of a commercially available mixture of hyaluronic acid, chondroitin sulfate, and poloxamer 407 on the damage caused by the exposure of esophageal mucosa to button batteries in an animal model. METHODS Experimental study. Sixty porcine esophageal samples were distributed in three groups: control (CG), exposure (EG), and exposure-protection (EPG). In EG and EPG, one CR2032 button battery per sample was inserted, both were subdivided into 2-, 4-, 6-, and 24-hour exposure subgroups, with subsequent battery removal. EPG samples were irrigated with the solution 1 hour after battery exposure. Esophageal pH and final voltage of the battery were measured. RESULTS pH in CG remained stable. No significant differences in pH at 1 hour were found between EG and EPG. In EPG, the pH of the mucosa exposed to the anode was lower than in GE at 2 hours (12.44 vs. 11.89, p = 0.203) and 4 hours (13.78 vs. 11.77, p < 0.0001). In the cathode pH was significantly higher in EG at 2 hours (2.5 vs. 4.11, p < 0.0001), 4 hours (2.33 vs. 4.78, p < 0.0001), and 6 hours (2.17 vs. 2.91, p < 0.0001). Significant voltage reduction at 1 hour was found in EG compared to EPG (0.48 vs. 1.08 V, p = 0.004). CONCLUSION Exposure to hyaluronic acid solution buffers the acidification on the side exposed to the cathode and basification on the anode. This effect can be maintained up to 3 to 5 hours, even after stopping its application. Our results suggest that a solution containing hyaluronic acid could be used as an esophageal protector after accidental ingestion of button batteries.
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Affiliation(s)
- I Bada-Bosch
- Department of Pediatric Surgery, Hospital Universitario Gregorio Marañón, Madrid, Spain
| | - M D Blanco Verdú
- Department of Pediatric Surgery, Hospital Universitario Gregorio Marañón, Madrid, Spain
| | - J A Cerdá
- Department of Pediatric Surgery, Hospital Universitario Gregorio Marañón, Madrid, Spain
| | - M Fanjul
- Department of Pediatric Surgery, Hospital Universitario Gregorio Marañón, Madrid, Spain
| | - J Ordoñez
- Department of Pediatric Surgery, Hospital Universitario Gregorio Marañón, Madrid, Spain
| | - M M Tolín Hernani
- Department of Pediatric Gastroenterology, Hepatology and Nutrition, Hospital Universitario Gregorio Marañón, Madrid, Spain
| | - C Miranda Cid
- Department of Pediatric Gastroenterology, Hepatology and Nutrition, Hospital Universitario Gregorio Marañón, Madrid, Spain
| | - C Sánchez Sánchez
- Department of Pediatric Gastroenterology, Hepatology and Nutrition, Hospital Universitario Gregorio Marañón, Madrid, Spain
| | - J C De Agustín
- Department of Pediatric Surgery, Hospital Universitario Gregorio Marañón, Madrid, Spain
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13
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Chiew AL, Chan BSH. Management of button battery ingestion. Clin Toxicol (Phila) 2023; 61:1017-1019. [PMID: 38270055 DOI: 10.1080/15563650.2023.2294622] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2024]
Affiliation(s)
- Angela L Chiew
- Member, Editorial Board Department of Clinical Toxicology, Prince of Wales Hospital, Randwick, NSW, Australia
| | - Betty S H Chan
- Editor Prince of Wales Clinical School, Faculty of Medicine, University of New South Wales, Sydney, NSW, Australia
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Vaucel JA, Gil-Jardine C, Paradis C, Enaud R, Labadie M. Pre-hospital triage of children at risk of oesophageal button battery impaction: the button battery impaction score. Clin Toxicol (Phila) 2023; 61:1047-1054. [PMID: 38270057 DOI: 10.1080/15563650.2023.2289358] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2023] [Accepted: 11/26/2023] [Indexed: 01/26/2024]
Abstract
INTRODUCTION Button battery ingestion in children can be fatal if oesophageal perforation occurs. Such children require chest radiography in the emergency department to determine the button battery position and number. Current guidelines recommend that a button battery impacted in the oesophagus should be removed within two hours. We developed a clinical tool (the button battery impaction score) to estimate the risk of oesophageal impaction and help determine the most appropriate healthcare facility for initial assessment, either a local medical centre or a medical centre with the infrastructure for endoscopic retrieval. METHODS A multi-centre retrospective study was conducted over seven years in eight French poison centres. We included patients aged less than 12 years with radiography showing the button battery position and a symptom description before radiography. Button battery impaction scores were calculated using backward stepwise selection. RESULTS AND DISCUSSION A total of 1,430 patients were included, of whom 86, 461, and 375 had a button battery in their oesophagus, stomach, and post-pyloric position, respectively. No button batteries were identified by radiography in 508 patients. Sixteen of thirty-five factors independently predicted oesophageal impaction before chest radiography (P < 0.05). After the backward stepwise selection, the following seven factors contributed to the button battery impaction score: cough, drooling, dysphagia/food refusal, fever, pain (unspecified location), vomiting, and button battery ≥ 15 mm. The button battery impaction score showed an area under the curve value of 0.87, a negative predictive value of 0.98, and a sensitivity of 0.86. No cases of death, stricture, or haemorrhage were observed in patients with negative scores, including those with oesophageal impaction. CONCLUSIONS A button battery impaction score used readily available data to predict the risk of oesophageal impaction after button battery ingestion and before chest radiography. When further validated, this rapid tool may be widely applicable in determining an appropriate facility for patient transfer to either a local medical centre or a medical centre with the infrastructure for endoscopic retrieval.
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Affiliation(s)
- Jules-Antoine Vaucel
- Centre Antipoison Nouvelle Aquitaine [Nouvelle Aquitaine Poison Control Center], Centre hospitalier et universitaire de Bordeaux, Bordeaux, France
- Pole urgence SAMU SMUR, Centre hospitalier et universitaire de Bordeaux, Bordeaux, France
| | - Cédric Gil-Jardine
- Pole urgence SAMU SMUR, Centre hospitalier et universitaire de Bordeaux, Bordeaux, France
| | - Camille Paradis
- Centre Antipoison Nouvelle Aquitaine [Nouvelle Aquitaine Poison Control Center], Centre hospitalier et universitaire de Bordeaux, Bordeaux, France
| | - Raphael Enaud
- Pediatric Gastroenterology Department, Centre hospitalier et universitaire de Bordeaux, service de gastro-entérologie pédiatrique, Bordeaux, France
| | - Magali Labadie
- Centre Antipoison Nouvelle Aquitaine [Nouvelle Aquitaine Poison Control Center], Centre hospitalier et universitaire de Bordeaux, Bordeaux, France
- Pole urgence SAMU SMUR, Centre hospitalier et universitaire de Bordeaux, Bordeaux, France
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15
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Di Mitri M, Parente G, Bisanti C, Thomas E, Cravano SM, Cordola C, Vastano M, Collautti E, Di Carmine A, Maffi M, D’Antonio S, Libri M, Gargano T, Lima M. Ask Doctor Smartphone! An App to Help Physicians Manage Foreign Body Ingestions in Children. Diagnostics (Basel) 2023; 13:3285. [PMID: 37892106 PMCID: PMC10606892 DOI: 10.3390/diagnostics13203285] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2023] [Revised: 09/07/2023] [Accepted: 10/12/2023] [Indexed: 10/29/2023] Open
Abstract
BACKGROUND Foreign body ingestion (FBI) represents the most common cause of emergent gastrointestinal endoscopy in children. FBI's management can be quite challenging for physicians because of the variability of the clinical presentation, and the decision tree becomes even more intricate because of patient-specific variables that must be considered in the pediatric age range (e.g., age of patients and neuropsychiatric disorders) in addition to the mere characteristics of the foreign body. We present an application for smartphones designed for pediatricians and pediatric surgeons based on the latest guidelines from the official pediatric societies. The app aims to help physicians manage FBI quickly and properly in children. MATERIALS AND METHODS The latest pediatric FBI management guidelines were reviewed and summarized. The flow chart we obtained guided the development of a smartphone application. A questionnaire was administered to all pediatric surgeon trainees at our institute to test the feasibility and helpfulness of the application. RESULTS An app for smartphones was obtained and shared for free on the Google Play Store and Apple Store. The app guides the physician step by step in the diagnostic process, analyzing all patient- and foreign body-specific characteristics. The app consultation ends with a suggestion of the most proper decision to make in terms of further radiological investigations and the indication and timing of endoscopy. A questionnaire administered to trainees proved the app to be useful and easy to use. CONCLUSION We developed an app able to help pediatricians and pediatric surgeons manage FBI in children, providing standardized and updated recommendations in a smart and easily available way.
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Affiliation(s)
- Marco Di Mitri
- Pediatric Surgery Department, IRCCS Sant’Orsola-Malpighi Polyclinic, Alma Mater Studiorum—University of Bologna, 40138 Bologna, Italy; (G.P.); (C.B.); (E.T.); (S.M.C.); (C.C.); (M.V.); (E.C.); (A.D.C.); (M.M.); (S.D.); (M.L.); (T.G.); (M.L.)
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Vaucel JA, Recher M, Paradis C, Labadie M, Courtois A, Michaud L, Petyt C, Guimber D, Tournoud C, Enaud R, Nisse P. Severe post-pyloric injury after button battery ingestion: Systematic literature review and case report. Arch Pediatr 2023; 30:501-504. [PMID: 37394366 DOI: 10.1016/j.arcped.2023.05.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2022] [Revised: 02/04/2023] [Accepted: 05/21/2023] [Indexed: 07/04/2023]
Abstract
BACKGROUND The health and safety hazards related to button batteries (BB) have been extensively studied, highlighting that the presence of a button battery in the esophagus is a life-threatening emergency. However, complications related to bowel BB are poorly evaluated and not well known. The objective of this review of the literature was to describe severe cases of BB that have passed the pylorus. CASE REPORT This case, from the PilBouTox cohort, is the first report of small-bowel occlusion following ingestion of an LR44 BB (diameter: 11.4 mm) by a 7-month-old infant with a history of intestinal resections. In this case, the BB was ingested without a witness. The initial presentation mimicked acute gastroenteritis evolving into hypovolemic shock. An X-ray revealed a foreign body stuck in the small bowel causing an intestinal occlusion and local necrosis without perforation. The patient's history of intestinal stenosis and intestinal surgery were the contributing factor of impaction. SYSTEMATIC LITERATURE REVIEW The review was performed using the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) statement. The research was conducted on September 12, 2022 through five database and the U.S. Poison Control Center website. An additional 12 severe cases of intestinal or colonic injury after ingestion of a single BB were identified. Of these, 11 were related to small BBs (< 15 mm) that impacted Meckel's diverticulum and one was related to postoperative stenosis. CONCLUSION In view of the findings, the indications for digestive endoscopy for extraction of a BB in the stomach should include a history of intestinal stenosis or intestinal surgery so as to avoid delayed intestinal perforation or occlusion and prolonged hospitalization.
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Affiliation(s)
- Jules-Antoine Vaucel
- Centre Antipoison de Bordeaux (Bordeaux Poison Control Center), Bordeaux University Hospital, Bordeaux Cedex 33076, France.
| | - Morgan Recher
- Univ. Lille, CHU Lille, ULR 2694 - METRICS: Évaluation des technologies de santé et des pratiques médicales, F-59000 Lille, France
| | - Camille Paradis
- Centre Antipoison de Bordeaux (Bordeaux Poison Control Center), Bordeaux University Hospital, Bordeaux Cedex 33076, France
| | - Magali Labadie
- Centre Antipoison de Bordeaux (Bordeaux Poison Control Center), Bordeaux University Hospital, Bordeaux Cedex 33076, France
| | - Arnaud Courtois
- Centre Antipoison de Bordeaux (Bordeaux Poison Control Center), Bordeaux University Hospital, Bordeaux Cedex 33076, France
| | - Laurent Michaud
- Services des urgences pédiatriques (Pediatric Emergency care], Lille University Hospital, Lille 59000, France
| | - Caroline Petyt
- Service de chirurgie digestive (Department of Digestive Surgery), Lille University Hospital, Lille 59000, France
| | - Dominique Guimber
- Service de gastro-enterologie, hépatologie et nutrition pédiatrique (Department of Pediatric Gastroenterology, Hepatology and Nutrition), Lille University Hospital, Lille 59000, France
| | - Christine Tournoud
- Centre Antipoison de Nancy (Nancy Poison Control Center), Nancy University Hospital, Nancy 54000, France
| | - Raphael Enaud
- Service de gastro-enterologie, hépatologie et nutrition pédiatrique (Department of Pediatric Gastroenterology, Hepatology and Nutrition), Bordeaux University Hospital, Bordeaux Cedex 33076, France
| | - Patrick Nisse
- Centre Antipoison de Lille (Lille Poison Control Center), Lille University Hospital, Lille 59000, France
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Akca Caglar A, Derinoz Guleryuz O, Tomar Güneysu S, Çolak Ö. Evaluation of Physicians' Knowledge About Honey/Sucralfate Treatments in Children With Button Battery Ingestion. Pediatr Emerg Care 2023; 39:797-800. [PMID: 37725763 DOI: 10.1097/pec.0000000000003046] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 09/21/2023]
Abstract
OBJECTIVES Ingestion of button batteries (BBs) causes serious mortality and morbidity. We aimed to evaluate the knowledge level of physicians working in pediatric emergency departments about the updated guidelines for BB ingestion and whether they used honey and sucralfate, which have proven positive effects in preventing mucosal damage, in their daily practice. METHODS A "Google Form" questionnaire was prepared and used to evaluate the approach of physicians who worked in pediatric emergency department with questions about pediatric patients who were admitted with the suspicion of BB swallowing. RESULTS A total of 263 physicians, 169 women (64.3%), with a mean age of 34.5 ± 7.3 years, participated in the study. Seventy-five percent of the participants were from tertiary care hospitals, and 60.8% had less than 5 years of pediatric emergency experience. Some 71.9% of the physicians who participated in the survey (n = 189) had no algorithm at their hospitals. Fifty-eight percent (n = 152) of the participants completely and correctly answered all our survey questions about battery swallowing. Fifty-eight (22.1%) of the participants administered sucralfate, and 12.2% (n = 32) used honey treatments in patients who swallowed BBs; 68.1% (n = 179) had never heard of the use of sucralfate, and 77.6% (n = 204) had never heard of honey applications before in the management of swallowed batteries. CONCLUSION It was determined that the physicians who managed pediatric battery swallowing cases had deficiencies in their treatment approaches, they had no protocol in their institutions, and the use of mucosal damage mitigation and neutralization treatments, such as honey and sucralfate, was insufficient.
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Affiliation(s)
- Ayla Akca Caglar
- From the Pediatric Emergency Department, Gazi University, Ankara, Turkey
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18
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Schmidt YM, Muensterer O, Wendling-Keim D. The use of honey in button battery ingestions: a systematic review. Front Pediatr 2023; 11:1259780. [PMID: 37842023 PMCID: PMC10569471 DOI: 10.3389/fped.2023.1259780] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/16/2023] [Accepted: 09/08/2023] [Indexed: 10/17/2023] Open
Abstract
Background Button battery (BB) ingestions may cause severe and possibly fatal complications, especially if the battery is located in the esophagus. The application of oral honey has recently been proposed by the National Capital Poison Center in the USA and in an ESPGHAN position paper in Europe, but clinical trials and experimental studies are limited. The goal of this systematic review was to analyze the evidence for this approach. Materials and methods A systematic review of clinical trials and experimental studies on the oral application of honey after BB ingestion in children was performed. Inclusion criteria according to the PICO format were patient age 0-18 years, ingestion of BB, oral administration of honey or other substances, all in vivo and in vitro studies, as well as reported complication rate, esophageal injury, and mortality. A manual search in the databases MEDLINE, Web of Science and Cochrane was performed to identify relevant search terms to form the following queries and to construct the extensive search. Furthermore, the search was extended by using snowballing on the reports reference lists. The review is registered at Research Registry. The identifying number is reviewregistry1581. Results We found four publications that investigated the effects of honey after button battery ingestion. Three of these presented experimental in vitro and in vivo results and one reported a clinical retrospective study of 8 patients. Conclusion Follow up studies are required to further elucidate the effectiveness of the treatment with honey. The time intervals in which the use of honey is effective is not clear. Furthermore, a physiological model is needed for in vitro testing, preferably mimicking peristalsis and dynamic flow of the applied substances. However, since it is easy to apply and of minimal risk in patients over one year of age, honey should be considered a possible treatment option during the interval between presentation and endoscopic removal of the retained BB. Systematic Review Registration https://www.researchregistry.com/browse-the-registry#registryofsystematicreviewsmeta-analyses/registryofsystematicreviewsmeta-analysesdetails/643e9df96750410027ee11b0/, identifier: reviewregistry1581.
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Affiliation(s)
- Yannick Michael Schmidt
- Department of Pediatric Surgery, Dr. von Hauner Children's Hospital, University Hospital, LMU Munich, Munich, Germany
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19
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Lorenzo M, Beno S. Evolving threat of pediatric ingestions: a discussion of cannabis and button batteries and their implications for children. Curr Opin Pediatr 2023; 35:316-323. [PMID: 36876321 DOI: 10.1097/mop.0000000000001238] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/07/2023]
Abstract
PURPOSE OF REVIEW Pediatric button battery and cannabis ingestions are rising in incidence and have the potential for significant harm. This review will focus on the clinical presentation and complications of these two common inadvertent ingestions in children, as well as recent regulatory efforts and advocacy opportunities. RECENT FINDINGS The rising incidence of cannabis toxicity in children has corresponded with its legalization across several countries in the last decade. Inadvertent pediatric cannabis intoxication is most commonly due to the ingestion of edible forms discovered by children in their own home. The clinical presentation can be nonspecific, therefore clinicians should have a low threshold for including it on their differential diagnosis. Button battery ingestions are also increasing in incidence. While many children are asymptomatic at presentation, button battery ingestions can quickly cause esophageal injury and lead to several serious and potentially life-threatening complications. Prompt recognition and removal of esophageal button batteries is essential for reducing harm. SUMMARY Cannabis and button battery ingestions are important for physicians who take care of children to recognize and manage appropriately. Given their rising incidence, there are many opportunities for policy improvements and advocacy efforts to make a difference in preventing these ingestions altogether.
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Affiliation(s)
- Melissa Lorenzo
- Division of Pediatric Emergency Medicine, The Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada
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20
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Huang JG, Tanpowpong P. Paediatric gastrointestinal endoscopy in the Asian-Pacific region: Recent advances in diagnostic and therapeutic techniques. World J Gastroenterol 2023; 29:2717-2732. [PMID: 37274071 PMCID: PMC10237107 DOI: 10.3748/wjg.v29.i18.2717] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/29/2022] [Revised: 02/12/2023] [Accepted: 04/14/2023] [Indexed: 05/11/2023] Open
Abstract
There has been a rapid expansion in the knowledge of paediatric gastroenterology over the recent decade, with a fast-growing repertoire of diagnostic techniques and management strategies for a wide spectrum of childhood gastrointestinal (GI) diseases. Paediatric GI endoscopy is a core competency every paediatric gastroenterologist should possess, and represents one of the most common procedures performed in children for both diagnostic and therapeutic purposes. Yet there remains a dearth of literature on the utility and outcomes of paediatric GI endoscopy in the Asia-Pacific region. Data on the diagnostic value of paediatric GI endoscopy would be an important aspect of discussion, with the emergence of inflammatory bowel disease (IBD) and eosinophilic GI disease as increasingly common endoscopic diagnoses. Time-based trends in paediatric GI endoscopy do point towards more IBD and gastroesophageal reflux disease-related complications being diagnosed, with a declining incidence of GI bleeding. However, the real-world diagnostic value of endoscopy in Asia must be contextualised to the region-specific prevalence of paediatric GI diseases. Helicobacter pylori infection, particularly that of multidrug-resistant strains, remains a highly prevalent problem in specific regions. Paediatric functional GI disorders still account for the majority of childhood GI complaints in most centres, hence the diagnostic yield of endoscopy should be critically evaluated in the absence of alarm symptoms. GI therapeutic endoscopy is also occasionally required for children with ingested foreign bodies, intestinal polyposis or oesophageal strictures requiring dilation. Endoscopic haemostasis is a potentially life-saving skill in cases of massive GI bleeding typically from varices or peptic ulcers. Advanced endoscopic techniques such as capsule endoscopy and balloon-assisted enteroscopy have found traction, particularly in East Asian centres, as invaluable diagnostic and therapeutic tools in the management of IBD, obscure GI bleeding and intestinal polyposis. State of the art endoscopic diagnostics and therapeutics, including the use of artificial intelligence-aided endoscopy algorithms, real-time confocal laser endomicroscopy and peroral endoscopic myotomy, are expected to gain more utility in paediatrics. As paediatric gastroenterology matures as a subspecialty in Asia, it is essential current paediatric endoscopists and future trainees adhere to minimum practice standards, and keep abreast of the evolving trends in the diagnostic and therapeutic value of endoscopy. This review discusses the available published literature on the utility of paediatric GI endoscopy in Asia Pacific, with the relevant clinical outcomes.
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Affiliation(s)
- James Guoxian Huang
- Division of Gastroenterology, Hepatology and Nutrition, Department of Paediatrics, Khoo Teck Puat-National University Children’s Medical Institute, National University Health System, Singapore 119228, Singapore
- Department of Paediatrics, Yong Loo Lin School of Medicine National University of Singapore, Singapore 119228, Singapore
| | - Pornthep Tanpowpong
- Department of Paediatrics, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok 10400, Thailand
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21
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Scalise PN, Durgin JM, Staffa SJ, Wynne N, Meisner J, Ngo P, Zendejas B, Kim HB, Demehri FR. Pediatric button battery ingestion: A single center experience and risk score to predict severe outcomes. J Pediatr Surg 2023; 58:613-618. [PMID: 36646540 DOI: 10.1016/j.jpedsurg.2022.12.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/08/2022] [Accepted: 12/12/2022] [Indexed: 12/24/2022]
Abstract
PURPOSE The purpose of this study was to analyze the management and outcomes of primary button battery ingestions and their sequelae at a single high-volume center, and to propose a risk score to predict the likelihood of a severe outcome. METHODS The medical record was queried for all patients under 21 years old evaluated at our institution for button battery ingestion from 2008 to 2021. A severe outcome was defined as having at least one of the following: deep/circumferential mucosal erosion, perforation, mediastinitis, vascular or airway injury/fistula, or development of esophageal stricture. From a selection of clinically relevant factors, logistic regression determined predictors of a severe outcome, which were incorporated into a risk model. RESULTS 143 patients evaluated for button battery ingestion were analyzed. 24 (17%) had a severe outcome. The independent predictors of a severe outcome in multivariate analysis were location of battery in the esophagus on imaging (96%), battery size >/ = 2 cm (95%), and presence of any symptoms on presentation (96%), with P < 0.001 in all cases. Predicted probability of a severe outcome ranged from 88% when all three risk factors were observed, to 0.3% when none were present. CONCLUSION We report the presentation, management, and complication profiles of a large cohort of BB ingestions treated at a single institution. A risk score to predict severe outcomes may be used by providers initially evaluating patients with button battery ingestion in order to allocate resources and expedite transfer to a center with pediatric endoscopic and surgical capabilities. LEVEL OF EVIDENCE Level IV. TYPE OF STUDY Clinical Research Paper.
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Affiliation(s)
- P Nina Scalise
- Department of Surgery, Boston Children's Hospital, 300 Longwood Avenue, Fegan 3, Boston, MA, 02115, United States
| | - Jonathan M Durgin
- Department of Surgery, Boston Children's Hospital, 300 Longwood Avenue, Fegan 3, Boston, MA, 02115, United States
| | - Steven J Staffa
- Boston Children's Hospital, Department of Anesthesiology, Critical Care and Pain Medicine, Boston, MA, United States
| | - Nicole Wynne
- Department of Surgery, Boston Children's Hospital, 300 Longwood Avenue, Fegan 3, Boston, MA, 02115, United States
| | - Jay Meisner
- Department of Surgery, Boston Children's Hospital, 300 Longwood Avenue, Fegan 3, Boston, MA, 02115, United States
| | - Peter Ngo
- Boston Children's Hospital, Division of Gastroenterology, Hepatology and Nutrition, Boston, MA, United States
| | - Benjamin Zendejas
- Department of Surgery, Boston Children's Hospital, 300 Longwood Avenue, Fegan 3, Boston, MA, 02115, United States
| | - Heung Bae Kim
- Department of Surgery, Boston Children's Hospital, 300 Longwood Avenue, Fegan 3, Boston, MA, 02115, United States
| | - Farokh R Demehri
- Department of Surgery, Boston Children's Hospital, 300 Longwood Avenue, Fegan 3, Boston, MA, 02115, United States.
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Nugud AA, Tzivinikos C, Assa A, Borrelli O, Broekaert I, Martin-de-Carpi J, Deganello Saccomani M, Dolinsek J, Homan M, Mas E, Miele E, Thomson M, Benninga MA. Pediatric Magnet Ingestion, Diagnosis, Management, and Prevention: A European Society for Paediatric Gastroenterology Hepatology and Nutrition (ESPGHAN) Position Paper. J Pediatr Gastroenterol Nutr 2023; 76:523-532. [PMID: 36947000 DOI: 10.1097/mpg.0000000000003702] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/23/2023]
Abstract
Magnet ingestion is a special category of foreign body ingestion associated with high levels of morbidity and mortality worldwide, particularly if it is associated with staggered ingestion of multiple magnets or with simultaneous ingestion of other metallic foreign bodies, especially button batteries. A special category of magnet ingestion is the ingestion of earth magnets, which have higher levels of magnetism and therefore, potentially, carries a worse outcome. Legislative bodies, scientific Societies and community-led initiatives have been implemented worldwide with the aim of mitigating the effects of this growing, yet avoidable potential medical emergency. A scoping literature review summarized epidemiology, diagnosis, management, and prevention, including an algorithm for the diagnosis and management of magnet ingestion is presented and compared to previously published reviews and position papers (North American Society of Pediatric Gastroenterology, Hepatology and Nutrition, National Poison Center, Royal College of Emergency Medicine). The main emphasis of the algorithm is on identification of staggered/multiple magnet ingestion, and early joint gastroenterology and surgical consultation and management.
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Affiliation(s)
- A A Nugud
- From the Paediatric Gastroenterology Department, Al Jalila Children's Specialty Hospital, Dubai, United Arab Emirates
- Mohammed Bin Rashid University of Medicine and Health Sciences, Dubai, United Arab Emirates
| | - Christos Tzivinikos
- From the Paediatric Gastroenterology Department, Al Jalila Children's Specialty Hospital, Dubai, United Arab Emirates
- Mohammed Bin Rashid University of Medicine and Health Sciences, Dubai, United Arab Emirates
| | - Amit Assa
- The Juliet Keidan Institute of Pediatric Gastroenterology, Nutrition, Shaare Zedek Medical Center, The Hebrew University, Jerusalem, Israel
| | - Osvaldo Borrelli
- the Division of Neurogastroenterology & Motility, Department of Paediatric Gastroenterology, Great Ormond Street Hospital, London, UK
| | - Ilse Broekaert
- the Department of Paediatrics, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
| | | | | | - Jernej Dolinsek
- the Department of Pediatrics, University Medical Center Maribor, Maribor, Slovenia
| | - M Homan
- the Faculty of Medicine, University Children's Hospital, University of Ljubljana, Ljubljana, Slovenia
| | - Emmanuel Mas
- Service de Gastroentérologie, Hépatologie, Nutrition et Maladies Héréditaires du Métabolisme, Hôpital des Enfants, and IRSD, Université de Toulouse, INSERM, INRAE, ENVT, UPS, Toulouse, France
| | - Erasmo Miele
- the Department of Translational Medical Science, Section of Pediatrics, University of Naples "Federico II", Naples, Italy
| | - Mike Thomson
- the Department of Paediatrics, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
| | - Marc A Benninga
- the Department of Paediatrics, Emma Children's Hospital, Amsterdam University Medical Center, Amsterdam, The Netherlands
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23
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Kiefer A, Duppel U, Schützenmeier A, Lang T, Kittel J, Kabesch M, Kerzel S. Button Battery Ingestions cause the Majority of Severe Complications. KLINISCHE PADIATRIE 2023; 235:90-97. [PMID: 36758576 DOI: 10.1055/a-2007-1686] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/11/2023]
Abstract
BACKGROUND Foreign body ingestion in children is a clinically important reason for presentation to the emergency department. The individual outcome ranges from benign spontaneous courses to severe complications. Fatal outcomes occur rarely and complications are related to patient's age as well as type and location of the foreign body. The aim of our present study was to evaluate the outcome of children and adolescents with foreign body ingestion with a focus on complications, which mainly occurred after button battery ingestion. METHODS We reviewed medical records of patients between 0 and 18 years of age who had presented to the paediatric emergency department of our hospital with suspected foreign body ingestion between January 2011 and March 2021 (123 months). Clinical, imaging, and endoscopic data as well as treatment modalities were analysed. RESULTS In the ten10 year period under review, a total of 1,162 children and adolescents (6 months - 18 years) presented to our emergency room with suspected foreign body ingestion. Among those, 398 ingestions (34%) could be verified radiologically and/or endoscopically, while in the remaining 764 cases (66%) the suspicion could not be confirmed. The majority of patients with verified ingestion (n=324; 81%) presented with ingestion of a metallic foreign body. We observed 55 cases with verified ingestion of a button battery. Five of these cases had severe complications, with a near-fatal course in two patients who developed an oesophageal-tracheal fistula. CONCLUSION In contrast to all other ingestions of foreign bodies in children, button battery ingestions lead to mucosal damage and severe complications in a significant number of children.
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Affiliation(s)
- Alexander Kiefer
- Department of Paediatric Pneumology and Allergy, University Children's Hospital Regensburg (KUNO) at the Hospital St. Hedwig of the Order of St. John, Regensburg, Germany
| | - Uta Duppel
- Department of Paediatric Pneumology and Allergy, University Children's Hospital Regensburg (KUNO) at the Hospital St. Hedwig of the Order of St. John, Regensburg, Germany
| | - Alexander Schützenmeier
- Department of Paediatric Pneumology and Allergy, University Children's Hospital Regensburg (KUNO) at the Hospital St. Hedwig of the Order of St. John, Regensburg, Germany
| | - Thomas Lang
- Department of Paediatrics, Pediatric Gastroenterology, University Children's Hospital Regensburg (KUNO) at the Hospital St. Hedwig of the Order of St. John, Regensburg, Germany
| | - Jochen Kittel
- Department of Paediatrics, Pediatric Gastroenterology, University Children's Hospital Regensburg (KUNO) at the Hospital St. Hedwig of the Order of St. John, Regensburg, Germany
| | - Michael Kabesch
- Department of Paediatric Pneumology and Allergy, University Children's Hospital Regensburg (KUNO) at the Hospital St. Hedwig of the Order of St. John, Regensburg, Germany
| | - Sebastian Kerzel
- Department of Paediatric Pneumology and Allergy, University Children's Hospital Regensburg (KUNO) at the Hospital St. Hedwig of the Order of St. John, Regensburg, Germany
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24
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Beer M, Mentzel HJ, Steinborn M, Schaal MC. Acute care diagnostics in children for general radiologists - not alone in the hospital at night. ROFO-FORTSCHR RONTG 2023; 195:205-216. [PMID: 36261070 DOI: 10.1055/a-1948-1380] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/18/2023]
Abstract
BACKGROUND Radiologic care for children and adolescents during night and weekend shifts is challenging. This is especially true when a dedicated pediatric radiology front or background service is not available. METHODS The purpose of this review is to present the approach, the most relevant diagnoses, and their differential diagnoses based on four common example cases - abdominal pain, respiratory/chest pain, headache, and refusal to walk. Essentials such as clinical classification (e. g., disease dynamics) and practical instructions (e. g., necessity of acute cross-sectional imaging) are presented. RESULTS AND CONCLUSION For the abdomen, appendicitis ranks first among acute diseases. Other important diseases are intussusception and volvulus. Far more frequently, however, gastroenteritis is the cause of abdominal pain. Usually no imaging is required in this case. In unclear clinical situations, ultrasound may be indicated. In suspected pulmonary infections, chest imaging is limited to inconclusive cases and suspicion of complications such as pleural empyema. Major emergencies include (spontaneous) pneumothorax and aspiration. Headache is a common symptom. Immediate imaging is only necessary in cases of suspected acute inflammatory (meningitis/encephalitis) or vascular disease (e. g., hemorrhage due to vascular malformations). MRI is the primary imaging modality in these cases. Restricted walking/refusal to walk is a classic nonspecific sign, particularly of acute musculoskeletal disease, especially in younger children. Clinical examination is essential to narrow down the field of investigation. Besides the frequent and symptomatic coxitis fugax, the rare but serious (septic) arthritis/osteomyelitis must not be overlooked. KEY POINTS · Radiological care of children and adolescents is challenging, especially during night and weekend shifts.. · However, in close cooperation with the referring colleagues/clinics, the appropriate approach can be effectively determined even if the symptoms are not clear.. · The selection of the optimal imaging method is based on guidance and guidelines, but also on the condition of the child/adolescent.. · A silent or whimpering child is cause for alarm.. CITATION FORMAT · Beer M, Mentzel H, Steinborn M et al. Acute care diagnostics in children for general radiologists - not alone at night in the hospital. Fortschr Röntgenstr 2023; 195: 205 - 216.
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Affiliation(s)
- Meinrad Beer
- Department of Diagnostic and Interventional Radiology, University Hospital Ulm, Germany
| | - Hans-Joachim Mentzel
- Department of Radiology/Division of Paediatric Radiology, Jena University Hospital, Jena, Germany.,President, German Society for Pediatric Radiology, Jena, Germany
| | - Marc Steinborn
- Institute for Diagnostic and Interventional Radiology and Pediatric Radiology, Munich Municipal Hospital Group, Munchen, Germany
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25
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A Solution to Difficult Esophageal Button Battery Removals. J Pediatr Gastroenterol Nutr 2023; 76:e66. [PMID: 36417557 DOI: 10.1097/mpg.0000000000003663] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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26
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Al-Taie B, Rosvall O, Larsson M, Edholm D. Button battery injury causing an aorto-oesophageal fistula in a 1-year-old child - Sengstaken-Blakemore tube, a life-saving bridge during surgery. Paediatr Int Child Health 2023; 43:19-22. [PMID: 38018156 DOI: 10.1080/20469047.2023.2277506] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/28/2022] [Accepted: 10/26/2023] [Indexed: 11/30/2023]
Abstract
ABBREVIATION AEF: aorto-oesophageal fistula;BB: button battery;CTA: computed tomography angiography;ER: emergency room;GI: gastro-intestinal;SBT: Sengstaken-Blakemore tube.
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Affiliation(s)
- Baraa Al-Taie
- Department of Surgery, Linköping University Hospital and Department of Biomedical and Clinical Sciences, Linköping University, Linköping, Sweden
| | - Oda Rosvall
- Department of Surgery, Linköping University Hospital and Department of Biomedical and Clinical Sciences, Linköping University, Linköping, Sweden
| | - Magnus Larsson
- Department of Surgery, Linköping University Hospital and Department of Biomedical and Clinical Sciences, Linköping University, Linköping, Sweden
| | - David Edholm
- Department of Surgery, Linköping University Hospital and Department of Biomedical and Clinical Sciences, Linköping University, Linköping, Sweden
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27
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Labadie M, Vaucel JA, Courtois A, Nisse P, Legeay M, Medernach C, Patat AM, Von Fabeck K, Gallart JC, Tournoud C, Puskarczyk E. Button Battery Ingestion in Children (PilBouTox®): A Prospective Study Describing the Clinical Course and Identifying Factors Related to Esophageal Impaction or Severe Cases. Dysphagia 2023; 38:446-456. [PMID: 35841456 DOI: 10.1007/s00455-022-10485-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2022] [Accepted: 06/13/2022] [Indexed: 01/27/2023]
Abstract
In this study, we aimed to identify the factors related to esophageal impaction following button battery (BB) ingestion in children. PilBouTox, a prospective multicentric observational cohort study, was conducted from French Poison Control Centers between June 1, 2016 and May 31, 2018. Children (0-12 years old) with BB ingestion were included. After ingestion, patients were monitored for 21 days or more if they remained symptomatic (maximum 1 year). Causes of ingestion, clinical manifestations, medical management, and the outcomes were recorded. In total, 415 patients were included; among them, 35 had esophageal impaction and 14 had severe complications or died. Seven symptoms were closely related (relative risk (RR) > 30) to esophageal impaction: anorexia, drooling, dyspnea, fever, hemodynamic instability, pallor, and pain. Furthermore, BBs > 15 mm were related to esophageal impaction (RR = 19, CI95% [4.1; 88]). The absence of initial symptoms was a protective factor for esophageal impaction (RR = 0.013, CI95% [0.002; 0.1]). Nine symptoms were closely related (RR > 30) to major effects and death: dyspnea, cough, dysphagia, drooling, fever, hemodynamic instability, pain, pallor, and vomiting. Seven symptoms were related to esophageal impaction and their rapid recognition could help to ensure that the patient is taken to a health care facility. Nine factors were related to the major effects of BB ingestion. We recommended an X-ray as soon as possible to determine the position of the BB.Trial Registry: Clinical Trial ID: NCT03708250, https://clinicaltrials.gov/ct2/show/NCT03708250.
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Affiliation(s)
- Magali Labadie
- Centre Hospitalier et Universitaire de Bordeaux, Centre Antipoison Nouvelle Aquitaine [Nouvelle Aquitaine Poison Control Center], 1 Place Amélie Rabat Léon, 33000, Bordeaux, Aquitaine, France.
| | - Jules-Antoine Vaucel
- Centre Hospitalier et Universitaire de Bordeaux, Centre Antipoison Nouvelle Aquitaine [Nouvelle Aquitaine Poison Control Center], 1 Place Amélie Rabat Léon, 33000, Bordeaux, Aquitaine, France
| | - Arnaud Courtois
- Centre Hospitalier et Universitaire de Bordeaux, Centre Antipoison Nouvelle Aquitaine [Nouvelle Aquitaine Poison Control Center], 1 Place Amélie Rabat Léon, 33000, Bordeaux, Aquitaine, France
| | - Patrick Nisse
- Centre Antipoison [Lille Poison Control Center], Centre Hospitalier et Universitaire de Lille, 59000, Lille, France
| | - Marion Legeay
- Centre Antipoison [Angers Poison Control Center], Centre Hospitalier et Universitaire de Angers, 49000, Angers, Pays de la Loire, France
| | - Chantal Medernach
- Centre Antipoison de Paris [Paris Poison Control Center]-Fédération de Toxicologie, Groupe Hospitalier Lariboisière Fernand-Widal, 75000, Paris, Île-de-France, France
| | - Anne-Marie Patat
- Centre Antipoison [Lyon Poison Control Center], Centre Hospitalier et Universitaire de Lyon, 69000, Lyon, Auvergne-Rhône-Alpes, France
| | - Katharina Von Fabeck
- Centre Antipoison [Marseille Poison Control Center], Centre Hospitalier et Universitaire de Marseille, 13000, Marseille, France
| | - Jean-Christophe Gallart
- Centre Antipoison-SAMU 31 [Toulouse Poison Control Center], Centre Hospitalier et Universitaire de Toulouse, 31000, Toulouse, Midi-Pyrénées, France
| | | | - Christine Tournoud
- Centre Antipoison [East Poison Control Center], Centre Hospitalier et Universitaire de Nancy, 54000, Nancy, Lorraine, France
| | - Emmanuel Puskarczyk
- Centre Antipoison [East Poison Control Center], Centre Hospitalier et Universitaire de Nancy, 54000, Nancy, Lorraine, France
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28
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Demiroren K. Management of Gastrointestinal Foreign Bodies with Brief Review of the Guidelines. Pediatr Gastroenterol Hepatol Nutr 2023; 26:1-14. [PMID: 36816435 PMCID: PMC9911172 DOI: 10.5223/pghn.2023.26.1.1] [Citation(s) in RCA: 9] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/25/2022] [Revised: 07/09/2022] [Accepted: 08/30/2022] [Indexed: 01/15/2023] Open
Abstract
Foreign body (FB) ingestion is a common health problem that affects children more than adults. According to gastroenterologists' guidelines, the management of FB ingestion differs slightly between adult and children. This review aimed to compile adult and children guidelines and establish an understandable association to reveal the requirements and timing of the endoscopic procedure, which is the most effective and least complicated technique for gastrointestinal FBs. Coins, pins, and chicken and fish bones have been the most commonly ingested FBs. However, with their increasing use in recent years, large batteries with lithium-ion conversion, stronger magnets composed of rare earth metals, such as neodymium, and superabsorbent objects have become the most morbid and mortal, necessitating new management strategies. Although the approach to gastrointestinal FBs is controversial, with different treatment options available in different disciplines, many studies have demonstrated the efficacy and safety of endoscopic procedures. Many factors influence the timing of endoscopy, including the nature, size, and location of the ingested object and the patient's clinical condition.
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Affiliation(s)
- Kaan Demiroren
- Department of Pediatric Gastroenterology, University of Health Sciences, Yuksek Ihtisas Training and Research Hospital, Bursa, Turkey
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29
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Button Battery-Induced Necrotizing Keratoconjunctivitis: Case Report. Case Rep Ophthalmol Med 2022; 2022:7878031. [DOI: 10.1155/2022/7878031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2021] [Revised: 11/17/2022] [Accepted: 11/18/2022] [Indexed: 12/14/2022] Open
Abstract
We report a case of a 2-year-old girl who presented to the ocular emergency department with a button battery retained in the inferior fornix of the left eye for more than 48 hours. The child developed necrotizing keratoconjunctivitis, which was treated with antibiotics, amniotic membrane graft, prompt removal of button battery, and other supportive measures.
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30
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Machta J, Hyer W. Diagnosis, management and prevention of button battery ingestion in childhood: a European Society for Paediatric Gastroenterology Hepatology and Nutrition position paper. Arch Dis Child Educ Pract Ed 2022:archdischild-2022-324443. [PMID: 36410940 DOI: 10.1136/archdischild-2022-324443] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/11/2022] [Accepted: 11/04/2022] [Indexed: 11/22/2022]
Affiliation(s)
- Joseph Machta
- Paediatric Gastroenterology, The Royal London Hospital, Barts Health NHS Foundation Trust, London, UK
| | - Warren Hyer
- Paediatric Gastroenterology, Chelsea and Westminster Healthcare NHS Trust, London, UK
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31
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Bosschaert C, Van Renterghem K, Van de Putte D, Matthyssens L, Vande Velde S, De Bruyne P, De Bruyne R, Beel E, Van Biervliet S. Time Is Money in Case of a Button Battery Ingestion. JPGN REPORTS 2022; 3:e259. [PMID: 37168462 PMCID: PMC10158409 DOI: 10.1097/pg9.0000000000000259] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 07/07/2022] [Accepted: 08/10/2022] [Indexed: 05/13/2023]
Abstract
Button battery (BB) ingestion is a preventable pediatric health hazard with important morbidity and mortality due to complications. We present 3 pediatric patients with a complicated course after BB ingestion and discuss current guidelines. Urgent endoscopic removal is necessary for every BB impacted in the esophagus. A new strategy before endoscopic removal is the administration of honey or sucralfate. During endoscopy, rinsing the esophageal mucosae with acetic acid can neutralize the alkalic environment and prevent late complications. Prevention of ingestion needs to be pursued by increasing awareness and changing legislation of packaging of BB.
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Affiliation(s)
- Charlotte Bosschaert
- From the Department of Pediatrics, Ghent University Hospital, Ghent University, Ghent, Belgium
| | - Katrien Van Renterghem
- Department of Pediatric Surgery, Ghent University Hospital, Ghent University, Ghent, Belgium
| | - Dirk Van de Putte
- Department of Pediatric Surgery, Ghent University Hospital, Ghent University, Ghent, Belgium
| | - Lucas Matthyssens
- Department of Pediatric Surgery, Ghent University Hospital, Ghent University, Ghent, Belgium
| | - Saskia Vande Velde
- From the Department of Pediatrics, Ghent University Hospital, Ghent University, Ghent, Belgium
| | - Pauline De Bruyne
- From the Department of Pediatrics, Ghent University Hospital, Ghent University, Ghent, Belgium
| | - Ruth De Bruyne
- From the Department of Pediatrics, Ghent University Hospital, Ghent University, Ghent, Belgium
| | - Emma Beel
- Department of Paediatric Intensive Care, Ghent University Hospital, Ghent University, Ghent, Belgium
| | - Stephanie Van Biervliet
- From the Department of Pediatrics, Ghent University Hospital, Ghent University, Ghent, Belgium
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32
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Xu G, Chen YC, Chen J, Jia DS, Wu ZB, Li L. Management of oesophageal foreign bodies in children: a 10-year retrospective analysis from a tertiary care center. BMC Emerg Med 2022; 22:166. [PMID: 36195854 PMCID: PMC9533606 DOI: 10.1186/s12873-022-00723-4] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2022] [Accepted: 09/21/2022] [Indexed: 11/10/2022] Open
Abstract
OBJECTIVE Oesophageal foreign bodies (EFBs) are a common emergency issue in paediatrics, and few studies have revealed its clinical features and treatment methods. We conducted this retrospective study to provide our 10-year clinical evidence for the diagnosis and treatment of EFB and reduce the incidence of complications. METHODS We retrospectively reviewed all paediatric cases diagnosed with EFB from January 2012 to December 2021 at Shenzhen Children's Hospital. The age and sex of the patients, types of foreign bodies (FBs), preoperative examination, location and duration of FB impaction, clinical symptoms, surgical methods, therapeutic effects and complications were analysed. RESULTS Among the 1355 cases, 759 were boys and 596 were girls, with a median age of 2.9 years (4 months to 16 years). The shortest FB lodged time was 1 hour, while the longest time was 3 months. The types of foreign bodies included coins and blunt objects (812,59.9%), bones and sharp objects (278,20.5%), button batteries (86,6.3%), food impactions (84,6.2%), toys (51,3.8%) and plastic objects (44,3.2%). A total of 720 of 812 cases impacted by coins and blunt subjects were successfully treated with a Foley catheter without any complications. A total of 558 patients underwent rigid oesophageal endoscopy under general anaesthesia, and foreign bodies were successfully removed in 525 cases. No FB was found in 33 cases, and FBs pushed into the lower digestive tract during operation in 5 cases. Oesophageal injury was found in 130 cases (23.3%). Our study showed that the age of the patient, time of foreign body incarceration, type of foreign body, location of the lodged foreign body, and fever or cough were risk factors leading to oesophageal foreign body complications, and the differences were statistically significant (P < 0.05). CONCLUSION Children with EFB have a risk of complications, especially if the FB is a button battery. The appropriate surgical method should be selected through the analysis of the clinical characteristics of the foreign body in the oesophagus and the risk factors for complications to reduce the incidence of complications. Health education and effective care are the keys to the prevention of EFB.
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Affiliation(s)
- Guo Xu
- Department of Otorhinolaryngology, Shenzhen Children's Hospital, 7019 Yitian Road, Futian District, Shenzhen, 518038, Guangdong, China
| | - Yong-Chao Chen
- Department of Otorhinolaryngology, Shenzhen Children's Hospital, 7019 Yitian Road, Futian District, Shenzhen, 518038, Guangdong, China.,Department of Otorhinolaryngology, Shenzhen Children's Hospital, China Medical University, Shenzhen, 518038, Guangdong, China
| | - Jing Chen
- Department of Otorhinolaryngology, Shenzhen Children's Hospital, 7019 Yitian Road, Futian District, Shenzhen, 518038, Guangdong, China
| | - De-Sheng Jia
- Department of Otorhinolaryngology, Shenzhen Children's Hospital, 7019 Yitian Road, Futian District, Shenzhen, 518038, Guangdong, China.,Department of Otorhinolaryngology, Shenzhen Children's Hospital, China Medical University, Shenzhen, 518038, Guangdong, China
| | - Ze-Bin Wu
- Department of Otorhinolaryngology, Shenzhen Children's Hospital, 7019 Yitian Road, Futian District, Shenzhen, 518038, Guangdong, China.
| | - Lan Li
- Department of Otorhinolaryngology, Shenzhen Children's Hospital, 7019 Yitian Road, Futian District, Shenzhen, 518038, Guangdong, China.
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33
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Lanzafame LRM, Blandino A, Cicero G, Romeo P, Agati S, Zanai R, Celona A, Booz C, Koch V, Mazziotti S, D’Angelo T. Diagnosis and Management of Button Battery Ingestion Complicated by Tracheo-Esophageal and Aorto-Esophageal Fistulas. Diagnostics (Basel) 2022; 12:diagnostics12102369. [PMID: 36292059 PMCID: PMC9600074 DOI: 10.3390/diagnostics12102369] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2022] [Revised: 09/25/2022] [Accepted: 09/27/2022] [Indexed: 11/16/2022] Open
Abstract
Button battery ingestion (BBI) is common in children and its prevalence has increased in the last decades. BBI can be responsible for very severe and potentially fatal complications if not promptly detected. We describe the successful management of two cases of BBI that occurred in two previously healthy infants. Both patients presented with vague symptoms and no witness of foreign body ingestion. The prolonged time of exposure to the corrosive effects of disk batteries was responsible for the development of tracheo-esophageal fistula (TEF) and aorto-esophageal fistula (AEF). We demonstrate how prompt diagnosis and management are crucial for the infants’ survival.
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Affiliation(s)
- Ludovica R. M. Lanzafame
- Department of Biomedical Sciences and Morphological and Functional Imaging, University Hospital Messina, 98121 Messina, Italy
| | - Alfredo Blandino
- Department of Biomedical Sciences and Morphological and Functional Imaging, University Hospital Messina, 98121 Messina, Italy
| | - Giuseppe Cicero
- Department of Biomedical Sciences and Morphological and Functional Imaging, University Hospital Messina, 98121 Messina, Italy
| | - Placido Romeo
- Department of Diagnostic and Interventional Radiology, A.O.U. Policlinico San Marco, 95123 Catania, Italy
| | - Salvatore Agati
- Pediatric Cardiac Surgery, “Centro Cardiologico Pediatrico del Mediterraneo-Bambino Gesù”, 98039 Taormina, Italy
| | - Rosanna Zanai
- Pediatric Intensive Care Unit, “Centro Cardiologico Pediatrico del Mediterraneo-Bambino Gesù”, 98039 Taormina, Italy
| | - Antonio Celona
- Department of Radiology, “S. Vincenzo” Hospital Taormina, 98121 Messina, Italy
| | - Christian Booz
- Division of Experimental Imaging, Department of Diagnostic and Interventional Radiology, University Hospital Frankfurt, 60590 Frankfurt, Germany
| | - Vitali Koch
- Division of Experimental Imaging, Department of Diagnostic and Interventional Radiology, University Hospital Frankfurt, 60590 Frankfurt, Germany
| | - Silvio Mazziotti
- Department of Biomedical Sciences and Morphological and Functional Imaging, University Hospital Messina, 98121 Messina, Italy
| | - Tommaso D’Angelo
- Department of Biomedical Sciences and Morphological and Functional Imaging, University Hospital Messina, 98121 Messina, Italy
- Department of Radiology and Nuclear Medicine, Erasmus MC, 3015 Rotterdam, The Netherlands
- Correspondence:
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34
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Keil O, Avsar M, Beck C, Köditz H, Kübler J, Schwerk N, Zardo P, Sümpelmann R. [Case series report: Children undergoing complex surgery of tracheoesophageal fistula after ingestion of button batteries]. Laryngorhinootologie 2022. [PMID: 36170870 DOI: 10.1055/a-1887-8340] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2022]
Affiliation(s)
- Oliver Keil
- Klinik für Anästhesiologie und Intensivmedizin_Medizinische Hochschule Hannover, Hannover
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35
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Motohashi K, Thanacoody RHK. Toxicology in the emergency department: what's new? Br J Hosp Med (Lond) 2022; 83:1-16. [DOI: 10.12968/hmed.2022.0313] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Intentional and accidental drug overdose, recreational drug use and exposure to toxic substances are common reasons for people presenting to emergency departments. Although the mortality rate associated with these presentations is low in the UK, they can lead to significant morbidity and prolonged hospital admissions. This review discusses new developments in the management of paracetamol overdose. Several new protocols for the infusion of acetylcysteine, the antidote for paracetamol overdose, have been proposed in the past decade and evaluated in clinical studies. The 12-hour Scottish and Newcastle Acetylcysteine Protocol regimen and 20-hour Australian two-infusion bag protocol have been widely adopted into clinical practice and endorsed in national guidelines because of their shorter duration, reduction in adverse effects and efficacy in treating overdose. This article includes a care pathway that can facilitate the implementation of the Scottish and Newcastle Acetylcysteine Protocol. This article also discusses the emergency management of ingested button batteries, describes the emerging threat of novel psychoactive substances, and provides an update on new UK antidote guidelines. Further up-to-date guidance on management of clinical toxicology is available to healthcare professionals on the internet database TOXBASE.
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Affiliation(s)
- Kenzo Motohashi
- Translational and Clinical Research Institute, Newcastle University, Newcastle-upon-Tyne, UK
| | - Ruben HK Thanacoody
- National Poisons Information Service (Newcastle Unit), Newcastle-upon-Tyne Hospitals NHS Foundation Trust, Newcastle-upon-Tyne, UK
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36
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Tracheoesophageal Fistula after Button Battery Ingestion. J Pediatr Gastroenterol Nutr 2022; 75:e60. [PMID: 35666845 DOI: 10.1097/mpg.0000000000003505] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/10/2022]
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37
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Akinkugbe O, James AL, Ostrow O, Everett T, Wolter NE, McKinnon NK. Vascular Complications in Children Following Button Battery Ingestions: A Systematic Review. Pediatrics 2022; 150:189222. [PMID: 36032017 DOI: 10.1542/peds.2022-057477] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 06/08/2022] [Indexed: 11/24/2022] Open
Abstract
CONTEXT Children presenting to health care facilities with button battery (BB) impaction. OBJECTIVES To describe characteristics of children with vascular complications after BB impaction, as well as associated outcomes. DATA SOURCES National Capital Poison Center registry and PubMed database from inception to December 2021. STUDY SELECTION All reports describing children aged <18 years with vascular, esophageal, or airway complications after BB ingestion. DATA EXTRACTION We extracted characteristics including date of publication, age and sex of child, battery type and size, duration and location of impaction, complications, subsequent interventions, and interval between battery removal and death. RESULTS A total of 361 cases involved severe complications or death after BB ingestion (321 cases from the National Capital Poison Center registry database, 40 additional cases from PubMed). Nineteen percent (69 of 361) were fatal and 14% (51 of 361) involved vascular injuries. Three-quarters (75%) of vascular complications were aorto-esophageal fistulae and 82% of vascular injuries were not survivable. Fatal vascular cases had significantly longer median impaction time (96 hours versus 144 hours, P <.05) and a wider range of presenting features than survivors. LIMITATIONS The total number of cases with vascular complications was small, data reported varied between cases, and no data were available on overall exposure. Long-term morbidity data were not available for the survivors. CONCLUSIONS Prolonged BB impaction is a risk factor for vascular complications and death. A high index of suspicion is required for children representing with hematemesis after BB impaction, with prompt transfer to a tertiary center because vascular surgical intervention may offer a chance of survival.
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Affiliation(s)
| | | | - Olivia Ostrow
- Pediatrics, Division of Pediatric Emergency Medicine, The Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada
| | | | | | - Nicole K McKinnon
- Departments of Critical Care Medicine.,Department of Neuroscience and Mental Health, Peter Gilgan Center for Research and Learning, Hospital for Sick Children and University of Toronto, Toronto, Ontario, Canada
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Poddar U, Samanta A. Foreign Body Ingestion in Children: The Menace Continues. Indian Pediatr 2022. [DOI: 10.1007/s13312-022-2601-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Magnet and button battery ingestion in children: multicentre observational study of management and outcomes. BJS Open 2022; 6:6601283. [PMID: 35657136 PMCID: PMC9164827 DOI: 10.1093/bjsopen/zrac056] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2022] [Accepted: 03/30/2022] [Indexed: 02/04/2023] Open
Abstract
BACKGROUND Magnets and button batteries (BBs) are dangerous ingested foreign bodies in children. The scale and consequences of this public health issue in the UK are unknown. This study aims to report the current management strategies and outcomes associated with paediatric magnet and BB ingestion in the UK. METHODS This multicentre, retrospective observational study involved 13 UK tertiary paediatric surgery centres. Children aged under 17 years, admitted between 1 October 2019 and 30 September 2020, following magnet, or BB ingestion were included. Demographics, investigations, management, and complications were recorded. RESULTS In total, 263 patients were identified, comprising 146 (55.5 per cent) magnet, 112 (42.6 per cent) BB, and 5 (1.9 per cent) mixed magnet BB ingestions. Median (interquartile range) age was 4.8 (2.0-9.1) years and 47.5 per cent were female. In the magnet group, 38 (26.0 per cent) children swallowed single magnets, 3 of whom underwent endoscopic retrieval for oesophageal or gastric impaction. Of the 108 (74.0 per cent) children who swallowed multiple magnets, 51 (47.2 per cent) required endoscopic or surgical intervention, predominantly for failure of magnets to progress on serial imaging. Bowel perforations occurred in 10 children (9.3 per cent). Younger age and ingestion of greater numbers of multiple magnets were independently associated with surgery. BB ingestion caused morbidity in 14 children (12.5 per cent) and life-threatening injuries in two (1.8 per cent); the majority were caused by oesophageal BBs (64.3 per cent). CONCLUSION Multiple magnet and BB ingestions are associated with significant morbidity. Action must be taken at an international level to regulate the sale of magnets and BBs, and to raise awareness of the risks that these objects pose to children.
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Diagnostic et prise en charge des enfants ayant ingéré une pile bouton. TOXICOLOGIE ANALYTIQUE ET CLINIQUE 2022. [DOI: 10.1016/j.toxac.2022.04.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
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41
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Journal of Pediatric Gastroenterology and Nutrition-The Highlights of 2021. J Pediatr Gastroenterol Nutr 2022; 74:721-725. [PMID: 35849502 DOI: 10.1097/mpg.0000000000003480] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/10/2022]
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42
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Peng Y, Zhongmei H, Jiangtao Z, Yulan Y, Anyong Y. Secondary esophageal perforation rupture of ascending aorta 16 day accidently-swallowing button battery in a young child: A case report of esophagial foreign body and mini review. Int J Surg Case Rep 2022; 94:107148. [PMID: 35585711 PMCID: PMC9093002 DOI: 10.1016/j.ijscr.2022.107148] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2022] [Revised: 04/30/2022] [Accepted: 04/30/2022] [Indexed: 11/28/2022] Open
Abstract
Introduction and importance Foreign body ingestions often occur in children between the ages of six months and three years. Swallowing button battery can cause serious complications such as gastrointestinal mucosa tissue necrosis and esophageal perforation. Fatal secondary lesions after foreign body removal are rarely reported. Case presentation We reported a case of 18 months old boy who accidently swallowed a button battery (20 mm diameter, 3.2 mm height) which lodged in the esophagus for 3 days before removed by esophagoscope. Secondary esophageal perforation and rupture of ascending aorta resulted in death 13 days after the battery was removed. The autopsy confirmed the rupture and tissue necrosis of the esophagus and ascending aorta. Clinical discussion The button battery incarcerated in the second stricture of the esophagus can cause serious complications and death even after removal due to battery-induced tissue erosion. Great attention should be closely paid to early endoscopic reinspection postoperatively and take comprehensive treatment to avoid similar death. Conclusion When the incarceration of button batter occurs in the second stricture of esophagus, the possibility of esophageal perforation and the rupture of main artery should be considered. The comprehensive treatment after operation is as important as taking out the foreign bodies. 18 months old boy accidently swallowed a button battery which lodged in the esophagus for 3 days before removed by esophagoscope. Secondary esophageal perforation and rupture of ascending aorta resulted in death 13 days after the battery was removed. The button battery incarcerated in the second stricture of the esophagus can cause serious complications and death even after removal due to battery-induced tissue erosion. Great attention should be closely paid to early endoscopic reinspection postoperatively and take comprehensive treatment.
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Affiliation(s)
- Ye Peng
- Emergency Department, Affiliated Hospital of Zunyi Medical University, Zunyi 563003, Guizhou Province, China
| | - Hu Zhongmei
- Reproductive Medical Center affiliated to Zunyi Medical University, Zunyi 563003, Guizhou Province, China
| | - Zhang Jiangtao
- Zunyi Medical College, Zunyi 563003, Guizhou Province, China
| | - Yang Yulan
- Emergency Department, Affiliated Hospital of Zunyi Medical University, Zunyi 563003, Guizhou Province, China
| | - Yu Anyong
- Emergency Department, Affiliated Hospital of Zunyi Medical University, Zunyi 563003, Guizhou Province, China.
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Quitadamo P, Caruso F, del Monaco C, Fiori Nastro F, Verde A, Dolce P, Caldore M, Bucci C. Disc battery ingestion in paediatric age. Acta Paediatr 2022; 111:1615-1620. [PMID: 35416315 DOI: 10.1111/apa.16359] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/08/2022] [Revised: 04/01/2022] [Accepted: 04/05/2022] [Indexed: 11/29/2022]
Abstract
AIM The aim of the present study was to analyse clinical data of children referred for disc battery ingestion in order to assess short- and long-term reported injuries and to identify outcome predictors and trends, define the urgency of intervention and refine treatment guidelines. METHODS The records of all children admitted to Santobono-Pausilipon Children's Hospital, Naples, Italy for disc battery ingestion from January 2016 to December 2020 were retrospectively reviewed. Odds ratio were computed to assess the association between the different study variables and the rate of complications. RESULTS We enrolled 118 children. Mild to major complications related to the ingested disc batteries were reported in 12/118 (10.2%) patients. Disc battery oesophageal retention, disc battery diameter >20 mm, together with age below 1 year and symptomatic presentation were the most important factors associated with poor clinical outcome. CONCLUSION Our data confirm that ingested disc batteries are a serious health hazard and require a timely and qualified medical evaluation. We have identified three predictors of outcome severity: oesophageal retention, large-diameter cells and symptom onset. Disc batteries lodged beyond the oesophagus appear substantially harmless and we may support a more conservative approach.
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Affiliation(s)
- Paolo Quitadamo
- Digestive Endoscopy and Gastroenterological Emergency Unit Santobono‐Pausilipon Children’s Hospital Naples Italy
| | - Flora Caruso
- Digestive Endoscopy and Gastroenterological Emergency Unit Santobono‐Pausilipon Children’s Hospital Naples Italy
| | - Casimiro del Monaco
- Paediatric Surgery Unit Santobono‐Pausilipon Children's Hospital Naples Italy
| | - Francesca Fiori Nastro
- Department of Translational Medical Science Section of Pediatrics University "Federico II" Naples Italy
| | - Alessandra Verde
- Department of Translational Medical Science Section of Pediatrics University "Federico II" Naples Italy
| | - Pasquale Dolce
- Department of Public Health University of Naples Federico II Naples Italy
| | - Mariano Caldore
- Digestive Endoscopy and Gastroenterological Emergency Unit Santobono‐Pausilipon Children’s Hospital Naples Italy
| | - Cristina Bucci
- Digestive Endoscopy and Gastroenterological Emergency Unit Santobono‐Pausilipon Children’s Hospital Naples Italy
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Rostad BS, Richer EJ, Riedesel EL, Alazraki AL. Esophageal discoid foreign body detection and classification using artificial intelligence. Pediatr Radiol 2022; 52:477-482. [PMID: 34850259 DOI: 10.1007/s00247-021-05240-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/11/2021] [Revised: 10/05/2021] [Accepted: 10/31/2021] [Indexed: 01/04/2023]
Abstract
BACKGROUND Early and accurate radiographic diagnosis is required for the management of children with radio-opaque esophageal foreign bodies. Button batteries are some of the most dangerous esophageal foreign bodies and coins are among the most common. We hypothesized that artificial intelligence could be used to triage radiographs with esophageal button batteries and coins. OBJECTIVE Our primary objective was to train an object detector to detect esophageal foreign bodies, whether button battery or coin. Our secondary objective was to train an image classifier to classify the detected foreign body as either a button battery or a coin. MATERIALS AND METHODS We trained an object detector to detect button batteries and coins. The training data set for the object detector was 57 radiographs, consisting of 3 groups of 19 images each with either an esophageal button battery, esophageal coin or no foreign body. The foreign bodies were endoscopically confirmed, and the groups were age and gender matched. We then trained an image classifier to classify the detected foreign body as either a button battery or a coin. The training data set for the image classifier consisted of 19 radiographs of button batteries and 19 of coins, cropped from the object detector training data set. The object detector and image classifier were then tested on 103 radiographs with an esophageal foreign body, and 103 radiographs without a foreign body. RESULTS The object detector was 100% sensitive and specific for detecting an esophageal foreign body. The image classifier accurately classified all 6/6 (100%) button batteries in the testing data set and 93/95 (97.9%) of the coins. The remaining two coins were incorrectly classified as button batteries. In addition to these images with a single button battery or coin, there were two unique cases in the testing data set: a stacked button battery and coin, and two stacked coins, both of which were classified as coins. CONCLUSION Artificial intelligence models show promise in detecting and classifying esophageal discoid foreign bodies and could potentially be used to triage radiographs for radiologist interpretation.
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Affiliation(s)
- Bradley S Rostad
- Department of Radiology and Imaging Sciences, Emory University School of Medicine, 1405 Clifton Rd. NE, Atlanta, GA, 30322, USA. .,Emory + Children's Pediatric Institute, Children's Healthcare of Atlanta, Atlanta, GA, USA.
| | - Edward J Richer
- Department of Radiology and Imaging Sciences, Emory University School of Medicine, 1405 Clifton Rd. NE, Atlanta, GA, 30322, USA.,Emory + Children's Pediatric Institute, Children's Healthcare of Atlanta, Atlanta, GA, USA
| | - Erica L Riedesel
- Department of Radiology and Imaging Sciences, Emory University School of Medicine, 1405 Clifton Rd. NE, Atlanta, GA, 30322, USA.,Emory + Children's Pediatric Institute, Children's Healthcare of Atlanta, Atlanta, GA, USA
| | - Adina L Alazraki
- Department of Radiology and Imaging Sciences, Emory University School of Medicine, 1405 Clifton Rd. NE, Atlanta, GA, 30322, USA.,Emory + Children's Pediatric Institute, Children's Healthcare of Atlanta, Atlanta, GA, USA
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45
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Association between the corrosion of ingested lithium button battery in the esophagus and its complications in pediatric patients. Emerg Radiol 2022; 29:455-460. [PMID: 35182254 DOI: 10.1007/s10140-022-02033-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2021] [Accepted: 02/14/2022] [Indexed: 10/19/2022]
Abstract
PURPOSE The incidence of lithium button battery ingestion has been increasing recently, which results in severe complications. We aimed to demonstrate the association between the corrosion of lithium button batteries in the esophagus on radiographs and their complications. METHODS The nine pediatric patients included in this study were classified into two groups based on the presence of severe complications. The presence and degree of corrosion on plain radiographs were evaluated. The degree of corrosion was classified into the following three grades; none: 0%; moderate: 1-50%; severe: 51-100%. Fisher's exact test was used for statistical analyses. RESULTS Of the nine patients, five showed complications. The number of patients who had grade none, moderate, and severe degrees of corrosion was three, four, and two, respectively. The incidence of severe complications differed significantly between the incidence of lithium button batteries' contour (without vs. with severe complications [presence/absence of corrosion] = 1/3 vs. 5/0, respectively; P = 0.0476). In cases with "none" degree of corrosion, all three cases had no complication, and in cases with a "severe" degree of corrosion, all two cases had complications. CONCLUSION The cases with the presence of corrosion of lithium button batteries had a higher tendency to have severe complications. Therefore, physicians should anticipate the presence of severe complications in pediatric patients with corrosion more than those without corrosion.
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Fallberichte: Kinder mit tracheoösophagealer Fistel nach Knopfbatterieningestion. Anasthesiol Intensivmed Notfallmed Schmerzther 2022; 57:142-149. [DOI: 10.1055/a-1505-0674] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
ZusammenfassungFremdkörperingestionen bei Kindern nehmen stetig zu – dabei werden u. a. Knopfbatterien sehr häufig verschluckt. Das weitverbreitete Modell CR2032 führt bereits nach kurzer Zeit zu schweren
Laugenverätzungen mit möglicher Perforation in benachbarte Organe. Dieser Fallserienbericht stellt 4 Kinder vor, die nach Ingestion von Knopfbatterien eine tracheoösophageale Fistel
entwickelten und in unserer Kinderklinik interdisziplinär versorgt wurden.
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47
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Fraser JA, Briggs KB, Svetanoff WJ, Attard TM, Oyetunji TA, St Peter SD. Evaluation of a Symptom-Based Algorithm for Managing Battery Ingestions in Children. Eur J Pediatr Surg 2022; 32:2-8. [PMID: 34918312 DOI: 10.1055/s-0041-1740537] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
OBJECTIVES While complications from battery ingestion can be severe, especially with the emergence of stronger battery elements, not all ingestions require prompt removal. We aim to evaluate a symptom-focused algorithm for battery ingestion that emphasizes observation over intervention to investigate its safety. MATERIALS AND METHODS Patients were identified through a query of foreign-body ingestion radiographs obtained between 2017 and 2020. A retrospective chart review was then performed of all patients who presented with button battery ingestions to identify compliance with our algorithm, overall outcomes, and complications. RESULTS In total, 2% of all radiographs (44/2,237) demonstrated button battery ingestions. The median age of patients was 3.8 years (interquartile range, 2.6-5.3). Most batteries were found in the stomach (64%, n = 28), but were also identified in the esophagus (14%, n = 6), small bowel (14%, n = 6), and colon (9%, n = 4). All esophageal batteries were managed with immediate endoscopic retrieval. Ten gastric batteries were not managed per protocol, with seven admitted for observation despite being asymptomatic and repeat abdominal X-rays demonstrating persistent gastric location of the battery. Four patients underwent esophagogastroduodenoscopy; however, in two patients the battery had migrated past the stomach prior to intervention. All small bowel batteries and three of four asymptomatic colon batteries were managed per protocol; one patient had additional imaging that demonstrated battery passage. CONCLUSION Adherence to a symptom-focused protocol for conservative management of button battery ingestions beyond the gastroesophageal junction is safe and frequently does not require admission, serial imaging, or intervention.
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Affiliation(s)
- James A Fraser
- Department of Pediatric Surgery, Children's Mercy Hospitals and Clinics, Kansas City, Missouri, United States
| | - Kayla B Briggs
- Department of Pediatric Surgery, Children's Mercy Hospitals and Clinics, Kansas City, Missouri, United States
| | - Wendy Jo Svetanoff
- Department of Pediatric Surgery, Children's Mercy Hospitals and Clinics, Kansas City, Missouri, United States
| | - Thomas M Attard
- Department of Pediatrics, Children's Mercy Hospitals and Clinics, Kansas City, Missouri, United States.,Department of Gastroenterology, Children's Mercy Hospitals and Clinics, Kansas City, Missouri, United States
| | - Tolulope A Oyetunji
- Department of Pediatric Surgery, Children's Mercy Hospitals and Clinics, Kansas City, Missouri, United States
| | - Shawn D St Peter
- Department of Pediatric Surgery, Children's Mercy Hospitals and Clinics, Kansas City, Missouri, United States
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Sinclair EM, Santore MT, Agarwal M, Kitzman J, Sauer CG, Riedesel EL. Evolving Clinical Care in Esophageal Button Batteries: Impact of Expert-Opinion Guideline Adoption and Continued Gaps in Care. J Pediatr Gastroenterol Nutr 2022; 74:236-243. [PMID: 34724451 PMCID: PMC8799493 DOI: 10.1097/mpg.0000000000003346] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
BACKGROUND/OBJECTIVES Esophageal button battery impactions (BBI) in children pose a significant danger to children. Although there are expert-opinion guidelines to help manage this population, few studies detail the impact of guidelines on the clinical care of these patients. With this study, we aimed to describe the care of these patients before and following adoption of guidelines at a single center. METHODS Retrospective cohort study of patients with esophageal BBI at a single center, large volume, urban academic pediatric hospital system before adoption of expert-opinion guidelines (2007-2017) and following adoption (2018-2020). RESULTS Cohort was comprised of 31 patients before adoption and 32 patients following adoption of guidelines. Patient characteristics did not differ between groups. After 2018, significantly more patients received acetic acid irrigation, initial cross-sectional imaging, and serial cross-sectional imaging. There was also an increase in intensive care unit (ICU) stays, number of intubations, nil per os time, and hospital length of stay. There was no difference in patient outcomes. CONCLUSION This study describes a large cohort of pediatric esophageal BBI before and following adoption of guidelines. Findings detail increased adherence to guidelines resulting in more cross-sectional imaging which led to ICU stays, longer length of stays, and more nil per os time. This study emphasizes the need for multi-disciplinary guidelines as well as further multi-institutional study.
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Affiliation(s)
| | | | | | - Jamie Kitzman
- Pediatric Anesthesiology, Department of Anesthesiology and Pediatrics
| | - Cary G Sauer
- Pediatric Gastroenterology, Department of Pediatrics
| | - Erica L Riedesel
- Pediatric Radiology, Department of Radiology and Pediatrics, Children's Healthcare of Atlanta, Emory University School of Medicine, Atlanta, GA
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Rashed Y, Khalfan K. Button Batteries and High-Powered Neodymium Magnet Ingestion in Children. Open Access Maced J Med Sci 2022. [DOI: 10.3889/oamjms.2022.8292] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
BACKGROUND: Foreign body ingestions in pediatrics are present highly variably. For each case, it is important to consider the size of the child, the age of the child, the size of the object, and the inherently different risk of different objects ingested. It is important to note that regardless of the type of object, any foreign body should be removed from the esophagus. Over the past decade, the medical literature has particularly identified the potential for morbidity and mortality in cases of button battery and magnet ingestions.
AIM: This study aims to describe the complications and how to avoid them in addition to studying the role of early endoscopic intervention in cases of button batteries (BB) and multiple magnets ingestion in children.
METHODS: There were 151 children enrolled in the study, classified into two groups. The first group constitutes ninety children with BB, the other group sixty children with multiple magnets ingestion. In addition to one patient with both multiple magnets and battery ingestion, which are extracted endoscopically from the stomach without complication. BB detected in the upper gastrointestinal tract (GIT) in the esophagus, stomach, and duodenum in 70 patients were extracted endoscopically. Other 20 patients where the batteries were detected distal to duodenum were observed till the discharge of batteries was confirmed. In patients with multiple magnets, the magnets were in the upper GIT in 46 patients while found distal to the duodenum in 14 patients.
RESULTS: There were 151 children enrolled in the study, classified into two groups. The first group constitutes ninety children with BB, the other group sixty children with multiple magnets ingestion. In addition to one patient with both multiple magnets and battery ingestion, which are extracted endoscopically from the stomach without complication. BB detected in the upper GIT in the esophagus, stomach, and duodenum in 70 patients were extracted endoscopically. Other 20 patients where the batteries were detected distal to duodenum were observed until the discharge of batteries was confirmed. In patients with multiple magnets, the magnets were in the upper GIT in 46 patients while found distal to the duodenum in 14 patients.
CONCLUSION: This study put alarm that multiple magnets ingestion carries a high risk of gastrointestinal perforation compared to battery ingestion. Invitation to ban on the sale of products with high-powered neodymium magnets, such as Buckyballs and Buckycubes, and to keep BB difficult reachable by children. In addition to encouraging urgent endoscopic management of suspected BB or multiple magnets ingestion.
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50
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Lorenzo C, Azevedo S, Lopes J, Fernandes A, Loreto H, Mourato P, Lopes AI. Battery Ingestion in Children, an Ongoing Challenge: Recent Experience of a Tertiary Center. Front Pediatr 2022; 10:848092. [PMID: 35573958 PMCID: PMC9091558 DOI: 10.3389/fped.2022.848092] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/03/2022] [Accepted: 03/21/2022] [Indexed: 12/20/2022] Open
Abstract
INTRODUCTION Morbidity related to childhood battery ingestions (BI) has increased recently due to the expanding use of larger lithium cells. A prompt endoscopic removal is vital to prevent severe complications in cases of esophageal batteries (EB). MATERIALS AND METHODS A retrospective, descriptive study of admissions for BI requiring endoscopic removal in a tertiary hospital's pediatric emergency department (Jan. 2011/Dec. 2020). RESULTS We had 35 cases, with an increasing incidence in the last 6 years; median age, 26 m (8 m-10 years), witnessed ingestion in 86%. On the X-ray: 14 (40%) had an EB, 21 (60%), a gastric battery (GB). Symptoms were present in 57% (100% EB/24% GB), and vomiting was the most frequent (50%). Endoscopy revealed: EB, 13 (37%); GB, 17 (49%); duodenal battery, 1 (3%); no battery, 4 (11%). Median time to removal: EB, 7 h (2 h-21days); GB, 12 h (2 h-3 days). All the patients with EB on the X-ray (14) had severe mucosal injury (Zargar classification): Grade IIIa, 7 (50%); IIIb, 5 (36%); IV, 2 (14%). CT-scan showed perforation in 2 patients (total, 4; 29% of EB). In patients with GB (21), 14 (67%) had mucosal damage; 13 (93%), mild (< Grade III, two esophageal erosions); 1 (7%) IIIa (esophageal ulceration). A statistically significant association between exposure time, younger age or battery size and severity of endoscopic lesions was found in EB location. There were no mortality cases. Acute complications occurred in 57% of EB: infection, 50%; perforation, 29%; pneumomediastinum/stridor, 14%; pneumothorax/subglottic stenosis/hemodynamic instability, 7 vs. 0% GB. Stenosis subsequently developed in 6 (43%) of EB: mild, 4 cases (29%); severe, 2 cases (14%, one resolved after endoscopic dilation; one needed a gastrostomy and esophagocoloplasty). CONCLUSION We verified recent increase in admissions due to battery ingestions and associated complications, despite the availability of an emergency pediatric endoscopy team. The patients with EB had more severe mucosal injury and poorer short/long-term outcomes. Children with GB had milder lesions, although the presence of a GB did not exclude esophageal injury. The availability of actual data from national referral centers will support advocacy efforts among stakeholders, including industry representatives and policy makers, in preventing worldwide button battery injury.
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Affiliation(s)
- Cristina Lorenzo
- Paediatric Gastroenterology Unit, Department of Paediatrics, University Hospital Santa Maria, Centro Hospitalar Universitário de Lisboa Norte, EPE, Lisbon, Portugal
| | - Sara Azevedo
- Paediatric Gastroenterology Unit, Department of Paediatrics, University Hospital Santa Maria, Centro Hospitalar Universitário de Lisboa Norte, EPE, Lisbon, Portugal
| | - João Lopes
- Gastrenterology Service, University Hospital Santa Maria, Centro Hospitalar Universitário de Lisboa Norte, EPE, Lisbon, Portugal
| | - Ana Fernandes
- Paediatric Gastroenterology Unit, Department of Paediatrics, University Hospital Santa Maria, Centro Hospitalar Universitário de Lisboa Norte, EPE, Lisbon, Portugal
| | - Helena Loreto
- Paediatric Gastroenterology Unit, Department of Paediatrics, University Hospital Santa Maria, Centro Hospitalar Universitário de Lisboa Norte, EPE, Lisbon, Portugal
| | - Paula Mourato
- Paediatric Gastroenterology Unit, Department of Paediatrics, University Hospital Santa Maria, Centro Hospitalar Universitário de Lisboa Norte, EPE, Lisbon, Portugal
| | - Ana Isabel Lopes
- Paediatric Gastroenterology Unit, Department of Paediatrics, University Hospital Santa Maria, Centro Hospitalar Universitário de Lisboa Norte, EPE, Lisbon, Portugal.,Medical School, University of Lisbon, Lisbon, Portugal
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